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Against the Grain with Dr. Chad Edwards | Oklahoma City Prolotherapy| Podcast 9 – Part 3
Dr Chad Edwards: Are we treating- to use a little bit of a story, the first time I took ACLS. It’s advanced cardiac life support. It’s where you learn how to run a code, their heart stopped and all those things. I took this and we’re going through the different rhythms and we look at there’s a rhythm called pulseless electrical activity. What that means is the heartbeat looks normal on the monitor, it looks like it’s normal but you check the pulse and there’s no pulse.
Brian Wilkes: Wow.
Dr Chad Edwards: If you look at the monitor, the patient looks fine.
Brian Wilkes: Is it some sort of electrical way that is giving out?
Dr Chad Edwards: The electrical activity in the heart usually corresponds to the mechanical activity of the heart. Usually those two would go together. The old term I think was electromechanical dissociation, EMD. That was an old term, probably dates me back to like Paul Harvey and the other stuff that you’ve mocked me about in the past.
Brian Wilkes: I love hanging out with you though because all the discounts you get for AARP and stuff like that. It’s fantastic.
Dr Chad Edwards: You’re awesome. [crosstalk 00:13:01]
Brian Wilkes: It pays to have older friends. I wanted to see [inaudible 00:13:07] by the way I know you’re old but I love this analogy though. See you can literally look at the pulse on the monitor and you got no pulse with the person. That’s amazing.
Dr Chad Edwards: The monitor looks normal, the patient is dying. If you ignored what the patient said and just treated the monitor you’re doing a great job, but and I’ll tell you- in the ACLS course they often say treat the patient not the monitor, treat the patient not the monitor. Yet when I get out and start doing my clinical rotations from medical school I go in and start working on thyroid and the patient says they feel awful and their TSH is normal because they are on Synthroid. I come out and I say the patient says they feel awful but the TSH is normal and they are saying treat the monitor not the patient, treat the monitor not the patient.
I’m like, “But you just told me to treat the patient not the monitor.” We like completely disconnect that or we’ll blame it on something else or we’ll not know or most of the time it’s because we don’t know. Another reason is this interconnected nature of the body and when we talk about a functional medicine approach, we’re looking at how everything interacts with everything else. We could have a stress response from the brain altering what’s called the hypothalamic pituitary adrenal axis which can have an effect on the thyroid-
Brian Wilkes: That’s a mouthful.
Dr Chad Edwards: I know, I practiced that also.
Brian Wilkes: You went all doctor on me.
Dr Chad Edwards: These different processes that are impacted by a number of different things alter the function of the thyroid. We talked about T4.
Brian Wilkes: Right.
Dr Chad Edwards: TSH is this brain hormone that tells the thyroid what to do. We give Synthroid which is T4 which T4 feeds back to the brain, says we’ve got enough, shuts down production of T4 and so your TSH goes to normal. That’s this concept. We think we’re doing a great job but the problem is that T4 has a fraction of the activity of the active hormone which is T3. Now your thyroid gland primarily produces T4 but it does produce a small amount of T3. When we give you Synthroid we’re decreasing the brain telling the thyroid gland to do something.
We’re basically if you think about it like a factory making cars, we’re like outsourcing. This factory is no longer making cars. Well, the T3 that you were getting from your thyroid gland which is roughly about 10% depending on what study you look at, roughly about 10%. If we shut down the production from the thyroid gland you’re not getting that 10% either.
Brian Wilkes: Right.
Dr Chad Edwards: In some cases patients can actually feel worse because T3 is the form of the hormone that you really need and I have seen patients that were on T3 only medications with T3 levels that looks fantastic. Their T4 was in the toilet as in very, very low and then their TSH levels were very, very low but their T3 levels were appropriate and they felt fantastic. T3 is what you need. T3 is what you need, not Synthroid, not T4. Patients can have great T4 levels, great TSH levels and feel like crap and you adjust their thyroid. I can tell a story about that as well. That was actually a shocking story and I can tell it now or I can wait a minute.
Brian Wilkes: Let’s tell that story.
Speaker 4: It’s story time.
Dr Chad Edwards: I had a 94-year-old lady come in to see me. This was a very high functioning 94-year-old lady who lived in an assisted living facility. She walked with a walker but very, very pleasant lady and she had been doing very well. She was on a low dose of Synthroid and I had been seeing for a while. Then she comes in to see me one day with one of the caregivers, one of the activity directors in this facility. This lady was slumped over in her wheelchair like couldn’t sit up straight.
She said, “I’m weak.” They said she is not acting like herself at all. This is a problem and a definite change in how she was doing and we don’t know why. Of course because of the way she looked I’m like, “My goodness, this could be neurologic. I want to make sure she didn’t have a stroke,” all of these kinds of things. “Let’s check into that stuff.”
I actually sent her to a neurologist. I obtained an MRI of the brain and of course I got labs. One of the labs that I got is what’s called a reverse T3 but I also got TSH, T4, T3. I was taught in medical school that reverse T3 is hogwash. It’s not not real, it doesn’t really matter. I’m here to tell you that it does. This patient’s T4 was very appropriate. She was on Synthroid. Her T3 was very low and her reverse T3 was extremely elevated. Now, when you look at the biochemistry T4 is like the parent compound and it goes through an enzyme called a deiodinase. There’s different versions of that; 1,2,3 blah, blah, blah.