How Hashimoto's Affects Fertility, Hormones & Pregnancy

Intro: Welcome to the Ask Dr. Boyd podcast, where we ask real patients from my practice real questions to help you. We talk about hormones. We talk about longevity medicine. We talk about functional medicine. We hope you enjoy the episode. In this episode of Ask Dr. Boyd, we talked to Jamie. We talked about Hashimoto's. We talked about fertility. We talked about the birth control pill. Let's get into it.

Jamie Dodson: My name is Jamie Dodson. I'm 25 years old. I came to see you for many underlying issues that were not answered by previous doctors, and you helped me answer a lot of my questions. Um so, that's what I'm here to do today is continue.

Dr. Boyd: Great. So, welcome. Thank you for coming on Dr. Boyd Ask Dr. Boyd. I appreciate that. Uh our goal just like if I'm talking to you in the office, is to provide information for you today and for the people that watch Ask Dr. Boyd. Uh hopefully it will assist them and help them in trying to establish what is wrong with them and how they can develop a plan that will benefit them moving forward. So, welcome.

Jamie Dodson: Thank you.

Dr. Boyd: So, what brings you in today?

Jamie Dodson: So, first I wanted to ask what is Hashimoto's and why does it affect so many women?

Dr. Boyd: Great question. Introducing Hashimoto's I think is a fantastic topic to start with Ask Dr. Boyd. Hashimoto's is an autoimmune disease. It was initially described clear back in 1905 by a Japanese doctor, Dr. Hashimoto. And we have learned a lot since his initial diagnosis more than 100 years ago. Hashimoto's is an inflammatory condition of the thyroid. The medical term for it is autoimmune thyroiditis. And the thyroid is inflamed. That's the ITIS. And so, it's an autoimmune disease. Now, the interesting thing is lots of people have heard of autoimmune diseases, but they're not quite sure what that means. Let me give you an example. If you have a splinter in your finger, you look down at your finger, and that little tiny splinter hurts. It causes redness, it causes discomfort. That is basically what's going on in the thyroid. There is some invading organism, whether it's a heavy metal, whether it's an antibiotic, whether it's a toxin, whether it's a plastic, it enters through the stomach through what's called a permeability process. That means that the stomach, the things that hold the outside world out, have a breach in them. And so when we swallow, that allows that piece of plastic or heavy metal or toxin to enter through the stomach, and then it runs around the body, and in Hashimoto's, it lands on the thyroid gland. So you have a piece of plastic now that is attached to the thyroid gland. The body recognizes that as foreign. And so you've got these little soldiers, and you either going to be little female soldiers, and they're going to run around because they've been told by the brain of the stomach, "Hey, we've got an we've got a an intruder in our body, and that intruder needs to be removed." So these little soldiers run to the thyroid gland, and they say, "Haha, there's that piece of plastic." They grab the piece of plastic. Oftentimes, they grab a piece of the thyroid gland as well. So you've got a little thyroid molecule, and you've got the piece of plastic. The little soldiers grab it, they take it to to the lymphatic system, and exit through the through your poop, and get rid of that. Aha, we saved the thyroid from that gland. Now the problem is, that would be fine, fantastic, but while the body's removing that piece of plastic, you're drinking water that has plastic in them. And so, even though that's being removed, you've got new plastic coming in. And so, you get this cycle that is very difficult to breach or to stop. And the more plastic, the more toxins that land on the thyroid gland, more and more soldiers, and they're called antibodies, are are trying to remove that. And that causes more inflammation to the to the thyroid. Hence, the diagnosis of autoimmune thyroiditis, an inflammatory condition of the thyroid.

Jamie Dodson: So, what is your opinion on synthetic thyroid medications?

Dr. Boyd: So, synthetic, you know, there's this big debate. Should you take a biologic or should you take a synthetic? Now, what is the definition of a synthetic? That simply mean means that it's made in the lab using the same products as are necessary to create that thyroid hormone. So, your thyroid releases two hormones. One's called T4, thyroid four, and another one's called T3, thyroid three. So, 90% of the thyroid that's released, 90% of it is T4, 10% of it is T3. It's interesting though, the T4 has to be converted to T3 to go to the cell to do what it's supposed to do. And the thyroid has many specific functions, but it's the T3 that goes to the cell to do that. Synthetic, like Synthroid, which is the number one prescribed drug in the entire world now, or levothyroxine, are synthetic products. And so, they're T4. So, you take them first thing in the morning, they get absorbed, and then the body, using an enzyme, it's actually a vitamin B1 enzyme, converts that T4 to T3, which goes to the body. Mhm. So, synthetic, in my opinion, there's a better option. A biologic, I think, is a better option. And a biologic means that it comes from an animal. And we, in our practice in Epiphany, recommend Armour Thyroid or NP Thyroid or compounded thyroid. So, Armour Thyroid and NP Thyroid come from a thyroid from a slaughtered pig. I ask most patients, most patients are are meat eaters, bacon or ham or sausage. You have no problem eating that. Do you have a problem taking a biologic thyroid medication from from a pig? Well, if you just had bacon that that morning, then it would make sense that you would have no problem consuming a thyroid from a pig. Now, the interesting thing about a biologic from a pig, it's it's a T3 product. And so, I told you that T4 has to be converted to T3 to go to the body. In the Epiphany model, we recommend a biologic, but it also makes sense to us that why not just take a T3 to go to the body? Why do we need a product that needs to be converted? Because what happens if you're one of those people that is low in in vitamin B1 or you have an enzyme problem that does not convert T4 to T3? Well, guess what? You're not going to get a good application or good pass-through from T4 to T3, that conversion to go to the body. So, there's two reasons we we recommend biologic. Number one is it makes sense makes sense to us um because again, you eat bacon, you eat sausage, you eat ham. And it's also a T3 drug. And so, synthetic versus biologic, we think biologic makes more sense in the biology of life.

Jamie Dodson: So, what is the connection between thyroid issues and autoimmune diseases?

Dr. Boyd: So, they're they're two separate problems, but oftentimes they're overlapped.

Jamie Dodson: Mhm.

Dr. Boyd: The difference between an autoimmune disease and thyroid disease is there's many autoimmune diseases, and thyroid disease uh can be uh by itself alone, or thyroid uh problems can be part of an autoimmune disease like Hashimoto's. So, if if we break these down, what is the difference between a an autoimmune disease and thyroid, are they connected? Uh I want you to have one pile over here with autoimmune diseases, and and and in this pile Hashimoto's would be one, lupus would uh would be another, Sjogren's syndrome would be another, rheumatoid arthritis would be another. Most likely type 1 diabetes is an autoimmune disease, and it would be in that in that process. And again, the the autoimmune simply means that something enters our body, our body recognizes it as foreign, and the body tries to destroy that, and in doing that, the body oftentimes destroys its own body. So, autoimmune means self-immune, it its own immunity is trying to destroy whatever's in there. People get confused on this because they think autoimmune, the body's just destroying me. The what the body's doing is it's trying to remove the offending agent that has entered the body, and trying to remove that, the body is injured or damaged. Thyroid disease simply means a problem with the thyroid. Now, there's hyperthyroidism, which is too much thyroid. There's hypothyroidism, which is too low of thyroid. Sounds like the uh the the three bears, doesn't it? Goldilocks and the three bears. And then, there is the autoimmune disease of of thyroid disease called Hashimoto's that we've talked about. It interesting, though, if you look at the number of people that have hypothyroidism versus hyperthyroidism, it's dramatically higher in the in the hypothyroidism group versus hyperthyroidism. So, in kind of in kind of an incredible statistic, after the age of 40, and you're less than 40, but after the age of 40, 40% of all women have hypothyroidism. Too low of thyroid. And they So, they need to supplement. And we've talked about either Synthroid or levothyroxine or Armour Thyroid or NP Thyroid, which is the best product, but it's interesting hypothyroidism is increasing, and we don't really know why, irrespective of the autoimmune disease. Hypothyroidism is increasing in number. I just mentioned a few minutes ago that Synthroid is is is the most prescribed drug in the entire world now. I have never seen to speak of hypothyroidism in men. And And it's interesting Epiphany is a We take care of both women and men, and we are seeing hypothyroidism thyroidism in men, and we're seeing Hashimoto's in men. Again, very very interesting. So, Epiphany's message message for all women out there for sure after the age of 40, we think you should have your thyroid checked twice per year. Uh the standard protocol for many offices is that you check your thyroid once a year after the age of 40, but if you get your thyroid checked, and then next month you become hypothyroid, you're going to spend an entire year feeling poorly uh before you get diagnosed. The other thing that I I think is very very important, Epiphany is very specific on this. We do a an entire thyroid uh blood test panel when we evaluate women. Traditional medicine is typically they check a TSH and a free T3, sometimes a free T3. When I was a traditional medicine doctor, I never checked for antibody levels. We started doing that when Epiphany was created 3 years ago and we have over 300 patients in our two practice locations with Hashimoto's. There's two parts to that. Number one is autoimmune diseases are increasing and then number two, we're checking for autoimmune diseases and obviously if we don't check, we don't know if people have autoimmune diseases. And so two times a year is is is highly recommended and even in your age group, it probably would be a good idea. We've used 40 as the number but maybe it should be really women all the way down to 20, maybe down to 15 that we should be checking their thyroid. So we check a free a TSH, a free T4, a free T3. Sometimes we check it what's called a reverse T3. We check a TPO which is the thyroid antibody. And then we also check a thyroglobulin antibody cuz sometimes women will have an elevation of one antibody panel which is called the TPO, thyroid antibody. The other one is is called a thyroglobulin antibody. You'll see an elevation of TPO and the thyroglobulin antibody will be normal and vice versa. So if you want to get a clear picture, do you, Jamie, have Hashimoto's, then both antibodies need to be obtained.

Jamie Dodson: And what is the relationship between thyroid function and gut health in women?

Dr. Boyd: That is a great question. So gut health and thyroid function, just like gut health and overall health are hand in hand. I mean they they should be it should be like a glove.

Jamie Dodson: Mhm.

Dr. Boyd: Gut health is one of the most complicated processes of health in all of all all of humans, both men and women. And if you look at one of the most common reasons people come to the doctor, it's back pain and belly pain. And and many times it's the belly pain that causes the back pain cuz if you you get a lot of gas in your colon, it pushes on your lower back which causes back pain.

Jamie Dodson: Mhm.

Dr. Boyd: Gut health though is is probably the genesis maybe of all illness in humans. Now, that's a huge statement, I understand. But, we have two brains in our body. We have our brain here, and we have our brain in our gut. And it's our brain in our gut that allows the immune process to work effectively. You think through COVID, people that had poor immunity died. People that had good immunity lived. Even if they had a really bad case of COVID, they survived. So, we'll start the process here. Your Your gut health actually starts in your mouth. And and obviously goes all the way to your anus. And anything in between there needs to be looked at as a complete organ. The start point, the mouth. The end point, the anus. So, bad teeth, bad dentures, poor dentition is the genesis for a lot of bad health because of the bacteria that originates there. And that gets swallowed, and and then that passes bad bacteria to the rest of the colon. So, the colon is set up uh where you need good bacteria, and you need bad bacteria. And they need to be in synergy. And if they're not, then what happens is gut health uh is not optimal, and you have bloating, abdominal pain, poor immune system. So, trying to understand how do you get there, we spend a lot of time at Epiphany creating good gut health. And several several things that are very important. We prescribe more antibiotics in the United States by a factor of five to one. I think the number's around 300 million prescriptions are written uh in the United States every year. Now, that's almost one prescription for every single patient in the United States. I believe the next number, number two, I think is per year. So we are out of sight. We way over prescribed antibiotics. Antibiotics destroy good bacteria in the colon. And it's it's amazing. One dose of antibiotics can destroy 80% of the good bacteria in the colon. Leaving bad bacteria to flourish which creates a lot of problems. So an epiphany model would be say hey Jamie, be very careful when you take antibiotics that you're taking antibiotics because you really need them. For example, if you had a really bad kidney infection, yes, you need antibiotics. I don't want you die from sepsis because you have a bad kidney infection and you don't want to protect you don't want to damage your gut. But in treating you with that, you want to take antibiotics the minimum amount of time that's going to treat your infection. Coexistently with that, we would want you on probiotics. And so we use a company called Biote. They have a great probiotic. You should be taking that every day because life happens and you get sick and we always want to maintain good gut health. So we would want that. We are we highly recommend kombucha. Kombucha is fermented black tea. We love the kombucha brand called Synergy and 6 oz of Synergy every day allows good gut health. So understanding gut health and and and and establishing what we think is is very important medical treatment improving immunity. Maintain good gut health. And that then will increase your chances of not getting sick. And so those two are very very closely related.

Jamie Dodson: What is the relationship between thyroid function and gut health?

Dr. Boyd: So gut health is as we talked about it very very important in maintaining the immune system and the permeability of the gut creates the problem where we have bad players enter our body. Those bad players can migrate to the thyroid and cause Hashimoto's. These bad players that enter through permeable permeable gut can also end and land on other parts of the body and and create what's called endocrine disruption or endocrine dysplasia or endocrine disruption and endocrine disease. That then can affect the thyroid in a very negative way.

Jamie Dodson: It's kind of like moving on to trying to conceive, but the same kind of thing is what everyday things like alcohol, plastic, sleep, stress affect gut inflammation and thyroid function and couples trying to conceive.

Dr. Boyd: So, obviously the conception rate and trying to conceive is a big deal for people your age and we we know how exciting that is. Sometime between 20 and 35 most couples make a decision that they want to move forward with pregnancy. Very interesting as a woman, it's very interesting you're plugging along with life and then you wake up one morning and you say, I'm ready to have a baby and then you say to yourself, what I wish I was pregnant today. Actually, I wish I was pregnant yesterday. It's it's truly bam, I want to be pregnant. And so, how do you prepare for that day that you finally say, I'm ready to have a baby. And so, functional medicine is lifestyle, diet and activity. And so, let's just talk about lifestyle.

Jamie Dodson: Mhm.

Dr. Boyd: The importance of lifestyle, everybody is talking about cortisol over here. Everybody understands that cortisol is is a real problem. Everybody has elevated cortisol levels. Cortisol is a hormone that's released from the adrenal gland that's purpose is to fight or flight. Bad guys coming at you, you're going to fight them or you or you're going to run away. But once that event hap- it goes away, the cortisol levels should decrease. But oftentimes it doesn't. So, what in our lifestyle can we do to decrease that cortisol? Well, first of all, understand that if we're in stressful situations, we need to figure out how to get out of that, okay? Sleep, though, is a driving healthy uh module for maintaining uh lifestyle and decreased cortisol levels. So, what do I mean by that? You uh as as as a 25-year-old woman should be receiving 8 to 9 hours of good sleep every night. And and and you want to go to sleep at the same time. So, you want to go to sleep at 10:00, 11:00, whatever that number is. And if you add 8 hours, you know, you're either going to go 10:00 to 6:00, 11:00 to 7:00. But you want to make sure that that sleep and the introduction of rapid eye movement sleep is is paramount. So, in your bedroom, you have a you have a dark room. You have no noise. You don't go to sleep with um the uh TV on. And I will say blue light prior to getting bed, staying away from blue light is paramount importance. Uh blue light tells your melatonin to stay suppressed. So, if you've been uh on your phone, scrolling, TV without blue lights, you get into bed and your melatonin's still decreased. And so, your body can't uh doesn't know that it's supposed to get into rapid eye movement sleep and therefore you never get good sleep. So, you want to stay away from blue light in the evening time and you want to go to bed the same time and get up at the same time. So, that would be lifestyle. Diet. Diet is super super important. You want organic whole foods. Uh you want the term uh if you buy meat, you want uh grass-raised. But you also want uh or grass-fed, but you want grass-finished as well. And very very important the grass-finished becomes part of the issue. As a young healthy person, you want to minimize uh sugars and carbohydrates. You should be on a 100 g protein diet per day, and I recommend that you get a protein app. At the end of the day, if I call you up and say, "Hey Jamie, what's what was your protein intake?" You can say, "I had 108 g of protein today." Okay, very very important. Uh activity. And everybody's definition of activity is different. I have an iWatch right here. And I my red line is I want to go to bed at night with a minimum of 5,000 steps per day, okay? Now, in in concert with that, I want to lift weights. Uh I want to increase my cardiovascular rate, but 5,000 steps is my minimum. I would say the same thing to you. Even at 8:30 or 9:00 at night, you're walking around the house to get your 5,000 steps. That's very very very important. Optimally, 10 10,000 would be better. We recommend uh lifting weights, and we recommend a technique called push, pull, leg. Uh you're a petite woman. Uh you want to maintain muscle mass. You're You're going to have a baby one of these days. You got to lift your baby up. And if you're uh weak because you have poor muscles, that's a problem. So, push, pull, leg. Uh there's great exercise physiologists that have created this program. It takes care of all the muscles in your body. You would want to do that 3 hours a week, Monday, Wednesday, Friday. And so, lifestyle, diet, and activity would prepare you for pregnancy. Now, as far as a vitamin goes, 40% of the country actually is 44 44% of the country has a gene defect called 5-MTHFR. What that means is you don't metabolize vitamins and minerals well. So, you need to take a methylated vitamin. And we recommend Gary Brecka's product, 10X Methylated Uh you would take two of those. It says it's for men, but you would take two of those, Monday, Tuesday, Wednesday, Thursday, Friday. Take the weekend off. Your husband would take three of those. Same thing, Monday through Friday, the weekend off. Obviously, we don't recommend that you smoke. Uh as far as alcohol, um you know, I I'm a big believer in wine. Jesus drank wine. I I I love wine, but you know, that doesn't mean every day you drink wine. So, a couple times a week would be fine. When you start the plan of getting pregnant, we encourage you to abstain from alcohol. That just makes sense.

Jamie Dodson: Okay, what happens long-term to inflammation, the gut, and hormones when women stay on their birth control pill for many years?

Dr. Boyd: So, the the your question of the association between the birth control pill uh and inflammation specifically. So, that is a fantastic question. So, the the association between the birth control pill and inflammation is very real. And uh and you have to understand why. The birth control pill tells the brain to suppress hormones, specifically estrogen and testosterone and progesterone. Why? Because you're trying not to get pregnant, okay? And so, the birth control pill tells the brain to tell the ovaries not to make an not to make an egg. And that's how you prevent pregnancy. But in doing that, it suppresses three of your hormones that are integrally important in your day-to-day life. So, if it suppresses estrogen, guess what? You have dry eyes, you have a dry mouth, you have a dry vagina. That means intercourse hurts for many, many women in your age group, and that's that's a problem. The birth control pill also decreases testosterone. Testosterone generates the desire to have a baby. So, you look at your husband using testosterone and say, "I want to have your baby." I want I want to have I want you to make a baby. I want to have your baby. And hopefully, he has testosterone, and he looks at you and says, "I want to have I want you to have my baby." So, testosterone is very necessary. The birth control suppresses all that. So, you can imagine how difficult this is. You've got a a testosterone issue, so you don't have libido. You've got a dryness issue, so when you have intercourse, it's painful. And so, doesn't work very well. And so, you're going along, you want to be pregnant, you come off the birth control pill, but those take a while, meaning your testosterone and your estrogen to return. And And sometimes they don't return for a long time, 6 months, 12 months, 18 months. And And you're very stressed during that period of time. So, how does the birth control pill cause inflammation? Well, if we go back and we say that your hormones are depressed, testosterone, which is a natural anti-inflammatory, so if you don't have testosterone, that would mean that potentially hormones are going to increase. Estrogen is a lubricator. Dry eyes, dry mouth, dry vagina. If you have any of those problems, that allows bacteria often times in the genital space from the rectum to the vagina, which can cause infection, because the estrogen is a protector. And so, if you don't have estrogen there, that increases your risk for vaginal infections, bladder infections, which is an inflammatory condition. As far as the gut goes, the birth control pill also suppresses enzymes in the gut that increase your risk for bloating, nausea. You As you know, many women when they get pregnant, they have nausea and vomiting. The same application can occur with the birth control pill. And And so, women frequently will will will state that they have nausea and vomiting uh with the birth control pill. That's an inflammatory condition many times.

Jamie Dodson: Does long-term use of the pill actually delay fertility?

Dr. Boyd: It absolutely can. And and studies show that. And traditional medicine like to say the birth control pill is no problem to come off of it. It may take up to 6 months for ovulation to return. But my experience, and I've seen thousands of patients in my career, that often times it can be longer than 6 months. Sometimes it can be 12 months. I've even seen uh women up to 18 months post-pill before ovulation would return. As I mentioned a little bit ago, when a woman decides she wants to be pregnant, she wants to be pregnant today. And so, you can imagine your anxiety every month now you're waiting for ovulation to return. And every month you're you're you're anxious, depressed because ovulation hasn't returned. And now we're out 6 months, 9 months, 12 months. The interesting thing about the pill also is sex hormone-binding globulin elevates on the birth control pill. Sex hormone-binding globulin is a hormone that that lands on the receptor in the body to prevent testosterone from working or estrogen working. So, if the birth control pill elevates SHBG, then when your ovulation or when your hormones start working, your ovaries start working and secreting estrogen and testosterone, if SHBG is elevated, that may prevent the estrogen and testosterone from working and doing their job. Remember, estrogen is necessary for ovulation. Testosterone's necessary for the drive to have to have a baby from an intercourse standpoint. And so, if both of those are depressed because of elevated SHBG, then that's going to cause a fertility issue.

Jamie Dodson: What's one or two lifestyle changes that actually move the needle on inflammation?

Dr. Boyd: Ha.

Jamie Dodson: Mhm.

Dr. Boyd: I would have to start with water and food. So, let's take water. I'm going to look at our community here in Fairhope. We have 16 So, if you do an EPA report on the Fairhope water, we have 16 toxins in our water. And And this is it's not uncommon in Fairhope. Many cities have the same thing.

Jamie Dodson: Mhm.

Dr. Boyd: But, toxins create inflammation. We've talked about gut permeability, and if those toxins get into into our body, they cause injury because inflammation. And so, putting a reverse osmosis system on your kitchen sink utmost important. Gary Brecka says, "Today should be the last day that you ever drink water out of your own faucet." So, reverse osmosis system, they're not very expensive. They go right Do-it-yourselfers can put them right under the kitchen cabinet. And it's a dedicated water source. So, that would be number one. Number two, put filters on all your showers. Our skin is our largest organ. If I can put a patch on my arm that gives me a hormone or gives me a narcotic like morphine, we know that patches secrete medicine right into our body, then it would make sense that if water hits our skin, which is our largest organ, that those toxins can enter our body and do exactly the destruction that we've talked about earlier. Food. Food is I think it was I I think Bobby Kennedy says that 70% of all of our food is bad for us. That's an incredible statistic.

Jamie Dodson: Mhm.

Dr. Boyd: So, we need organic whole food. And And even the organic industry, you've got to be cautious that they're not that they're not being dishonest when they say it's organic. I mentioned earlier meats, grass-fed, grass-finished. What do I mean by that? If a If a cow is grass-fed, what happens is the last 3 months of their life, to fatten them up, they feed them grains. Well, the grains have toxins on them. And so, that means the last 3 or 4 months of their life they're going to consume toxins which you're going to consume when you eat that meat. And so reverse osmosis system, organic whole foods would be two lifestyle changes that would decrease inflammation.