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thyroid diagnosis missed

What’s The Episode About?

In this episode, I’ll be sharing with you how traditional medical training actually puts medical providers into certain boxes, and subsequently, puts you as the client or the health care recipient, in the boxes as well.

Those boxes are actually the ones that cause you to be misdiagnosed when it comes to your thyroid conditions. The American Academy of Clinical Endocrinologists and the American Thyroid Association have bantered back and forth with other experts in the endocrinology community on what “healthy” bloodwork looks like and there always seems to be some misalignment.

Misalignment amongst the medical community and misdiagnosing may be affecting you.

In this episode I’ll dive into the truth so you can finally get the proper treatment you deserve and need.

Key Points Discussed:

  • The medical training of not thinking outside the box (01:05)
  • The problems caused by untreated low thyroid (06:23)
  • The lack of interpretive knowledge among medical providers (12:55)
  • Missed diagnosis from poor processes of taking patient history (17:00)
  • Functional, integrative, or naturopathic medicine can really help you with your thyroid type issues (22:35)

Where Can You Learn More?


When Was It Published?

September 26, 2019

Episode Transcript

Disclaimer: The Transcript Is Auto-Generated And May Contain Spelling And Grammar Errors


00:00          In today’s episode of The Optimal CEO Podcast, I’ll be sharing with you how traditional medical training actually puts medical providers into certain boxes, and subsequently, puts you as the client or the health care recipient, in the boxes as well, and these boxes actually cause you to be misdiagnosed when it comes to your thyroid conditions. So stay tuned as we will find out more how this phenomenon may be affecting you.


00:30          Here at The Optimal CEO Podcast, we help CEO entrepreneurs who love taking ownership of their wellness journey, but because they know it’s their most prized investment and when their state of wellness is at its peak, their income source. We want to help relieve CEO entrepreneurs from the pressure of unnecessary health exposure so they can be highly focused on growing their business and physically optimize for the journey so they can enjoy getting there.


01:05          Hi, I’m Dr. Brian Brown and I’d like to personally welcome you to today’s podcast episode. Thank you for joining me. So, what am I talking about boxes and being put in boxes. It’s one of these things that is just a term that I’ve come up with. It comes from the colloquialism of thinking outside the box. And, a lot of times we are browbeaten, and our medical training into not thinking outside the box. We have to follow certain algorithms. We have to follow the guidelines. And there’s nothing wrong with that. It gives us structure. However, it takes us away from the art of clinical practice. And, when it… when that happens, it takes us away from the nuances of being able to navigate the nuances of each individual person that’s sitting there in front of us in our exam room. So, when I talk about boxes related to thyroid, there’s a lot of controversy around this.


02:00          The American Academy of Clinical Endocrinologists, and the American Thyroid Association have bantered back and forth with other experts in the endocrinology community. See, endocrinologists are specialists that actually treat thyroid disorders, and they treat a plethora of other things like diabetes, and other conditions, but the bottom line is, they’re considered the experts when it comes to thyroid because it’s… the thyroid gland lies within the endocrine system. So, there’s been this huge debate since about 2002, is when we look at lab work, what’s normal lab work look like? Well, so they designed some studies and we wanted to look at some population studies, and find out what is a normal limit. While we know from that particular population study, or the studies that they subsequently did, that the younger you are, the more healthy your thyroid ranges seem to be. The older you are, the less healthy your thyroid ranges seem to be, at least from the way we view it in functional medicine.


03:05          For example, TSH may reign from a… and that’s thyroid-stimulating hormone. That’s a hormone released from a gland in the brain that tells the thyroid to release more thyroid hormone. So if it senses that the thyroid levels are low, it will actually release this thyroid-stimulating hormone or TSH. You’ll hear… hear me refer to that as. And, it will send that TSH to… signal to the thyroid saying, “Hey, we need more thyroid hormone. Please increase output.” So, in younger patients we’ll see… in 20 to 25 range, we’ll see TSH ranges be 0.45 in these population studies on the low end, to around 2.85, 2.95, maybe 3.0. Alright? So, in older patients, those that are 75 years of age and older, we’ll actually see that range queue far to the right. Meaning that the upper end of normal there will be in the 7.0 range.


04:11          Well, what we know and from previous medical studies, and in previous medical history, as well as the way functional medicine views this, is that anything, any TSH really over 3.0 is starting to raise a red flag of saying, listen, we’ve got some high, both thyroid is I’m going on. I see there’s this a seesaw type relationship. We call it an inverse relationship between TSH and your thyroid hormones. If your thyroid hormones are too low, hypo meaning low hypothyroid, those thyroid hormones are low, the TSH is going to be up. Remember, it’s a stimulating hormone, is telling the thyroid to produce more hormone. So anyway, there’s this huge debate on what’s normal. So there’s a huge range of accepted normal limits and a lot of cases you’ll find that if an elderly person say 75 years of age and older don’t have any cardiovascular type issues, they will allow the TSH to go to seven and not really bad.


05:14          And I, and that’s the current thinking out there. So several years ago, around 2012 there were some defined limits with an upper limit of around 4.12 and a lower limit of TSA to around 0.45 and guys, that’s just totally wrong. If you’ve got a person that’s struggling with subclinical hypothyroidism, meaning they have all the symptoms of thyroid, yet they don’t necessarily have the lab work to back it up, typically you’re gonna see that one, that TSH be on that upper end. So it’ll be 3.9 4.1 but as long as it’s under 4.12 nobody does anything it they raise those limits from around 3.0 to 4.1 to several years ago I think because insurance companies were happy to say, yes, let’s do that. It’s less lab work that we have to pay for. It’s less medication that we have to pay for and so on and so forth. The problem is, and this is the huge problem when thyroid is left untreated, I’m talking about low thyroid.


06:23          I’m not talking about high thyroid today. I’m talking about low thyroid. When low thyroid is left untreated, it leads to a whole host of problems, cholesterol problems, lipid problems, weight gain type issues, osteoporosis type issues, sleep issues and metabolism issues. The list goes on and on and on. There’s even evidence that having TSH on the low end, which means your thyroid hormones are healthy and when I say low in, I mean in the healthy low end you have less risk for atherosclerosis or cardiovascular disease. So there’s a lot of reasons why we need to stay on top of this yet it’s not being done and that’s what I wanted to open up with today so that we could start raising awareness as to this issue. Now in my book happiness hijackers, I’m gonna start reading and kind of going through some of the highlights of the book before the book launches.


07:21          If you want to know more information as far as how to get better access to when the book launches so you can be on the list and be notified. Just simply go to Brian g and Ford Slash Book and you’ll find all the information that you need and you can be on our list so that you get early notification. We’re actually going to be doing right when we first launched it and digital format and kindle format, we’re actually going to be giving them away for free for a very limited time, 24 to 72 hours. I haven’t really decided yet on that, but we’re going to be actually giving away the kindle version of the book. This is kind of my, my way of paying it forward and getting this information out there. So anyway, low thyroid is the first of three foundational hormones that everyone should monitor.


08:12          And in my opinion, and I consider it happiness hijacker number one. And if you read the book, you’ll understand what I’m talking about when the book gets launched and the book comes out. If you have a low thyroid, most medical providers do you usually respond and one of four ways inaccurately kind of categorizing you into a box. The boxes involving this hormone are oftentimes controversial, especially among medical providers. And I talked about that in my opening statement. So let’s review the boxes related to low thyroid and clear up the confusion and controversy around these boxes that we get put into. So box number one is it goes something like this. And I hear these stories all the time. You walk into your medical provider’s office and you say, you know, I just don’t feel right. Something is off. I don’t have any energy. I’m cold all the time.


09:04          I feel sad. I have brain fog and I’ve researched it online and I think I have low thyroid. So your medical provider says, okay, let’s check some lab work. And what that interprets too is they’re checking your TSH or your thyroid-stimulating hormone and likely not checking much else. If they do check other things, typically they’ll order a standard thyroid panel. And really that’s up to the laboratory what that panel looks like. In many cases, sometimes the clinician will actually get to choose what they want in their panel, but there are a lot of things that are in that thyroid panel that they don’t even know how to interpret and they rely heavily on the TSH or thyroid-stimulating hormone. So anyway, the medical provider checks your TSH level and they get back with you and they say, you know, I checked your thyroid and you’re fine.


09:55          You don’t need any thyroid hormone, and they just kind of pat you on the back and move you along your way. The thyroid box. Number two that I hear, this is a scenario that I hear all the time, is you go to your medical provider and you say the same thing. I don’t feel right. Something is off. I don’t have any energy. I’m cold all the time. I’m feeling sad, have brain fog, researched it. I think I have low thyroid and your medical provider checks the lab work and they get back with you. So in the first month they say, you know, I checked your thyroid and your TSH is too high. Remember there’s an inverse to kind of see Saul relationships. I mean, so thyroid hormones are low, your TSH is too high, you have low thyroid. I’m putting you on a synthetic thyroid medication called Leibow thyroxin, but thyroid treatment can be a little dangerous.


10:49          So I’m going to keep you on the smallest dose possible and then recheck your lab work. And month number two, your medical provider gets back with you and says, after they check your lab work and they say, oh, your TSH is too low, now you have too much thyroid on board, I’ll have to decrease your dose. Of levothyroxine. Now, if you’ll remember in that scenario, they already had you on the, one of the lowest doses of levothyroxine there was. So they’re having you cut the tablet in half or cut it in quarters or stopping it altogether. And month number six, they recheck your thyroid lab, the TSH, and they get back with you and they say, oh my goodness, your TSH is too high. Again, I’m not sure what’s going on. I’m going to refer you to a specialist. So they refer you to an endocrinologist, takes about three months to get in.


11:40          So in month nine you see this endocrinologist and the endocrinologist pats you on the back and says, your TSH is just fine. You don’t need anything. Go ahead and stop that medication. So those are two of the certain areas that play out. Here’s scenario number three of four. So you go into your medical provider and you tell your medical provider, I was family so bad that I went to one of those specialty clinics as functional medicine doctors and got put on natural thyroid medication. I feel so much better now. I can hardly stand it. I can think clearly. I have more energy. I’m sleeping better. My hair and nails are growing again and life is good. Your medical provider looks at you because you’re there for your annual physical and says, oh, that natural thyroid medication is horrible stuff. You shouldn’t be taking it. Let me see your original lab work and your medical provider looks at your original lab work because you’re a studious the healthcare consumer and you keep copies of your lab work and he looks you in the eye or she looks you in the eye and says, you should never have been put on thyroid medication in the first place because your TSH was perfectly fine.


12:55          You have to stop that medication now. It’s too dangerous and you reply to your medical provider, but doc, I, I feel so much better, and your medical provider looks at you and says, you’re playing with fire. It’s dangerous. You have to stop this stuff now. If you don’t stop it, you can no longer be a patient of mine. Guys, these are scenarios I’ve heard from people sitting right in my office and there are things that play out every single day because of lack of understanding. The last box I’m going to talk about today is thyroid box number four and you go into, you’re a medical provider and it’s the same scenario. I don’t feel right. I have brain fog. Something is off. I feel cold all the time. I feel sad. I think I have low thyroid because I’ve researched it online, so your medical provider checks your blood work as they should do and they tell you, I checked your thyroid blood work and you have positive thyroid antibodies.


13:54          You may need thyroid medicine, but I’m not comfortable prescribing it so I’m going to refer you to a specialist because you have an autoimmune thyroid condition. You go to the specialist and the specialist says, well, I’ve taken a look at your lab work and your TSH is normal, but because you’re an autoimmune patient, I’ll bring you back in three to six months to have your lab work rechecked again. Right now. I’m not going to prescribe anything now and these particular scenarios we run into a host of issues and scenario number one, we have the medical provider that checked the thyroid levels, whatever, how they checked and said, everything’s fine, patted you on the back since you on your way. That happens over and over again. This is probably the scenario that happens the most frequently and it boils down to a lack of an interpretation, lack of interpretive knowledge of what is in front of them.


14:55          However, you’re only as good as the questions you ask. See, personally, before I even check thyroid hormone, I am going to take a very thorough history. I want to know family history. I want to know if there’s any inclination of autoimmune disorders and I’m not concerned whether it’s a thyroid autoimmune disorder or not. I want to know if there’s a history of autoimmune disorders in the family because we know from research that history of autoimmune conditions and families can mean that some family members may have an autoimmune disorder that presents in a different organ system. For example, you may have one person that has type one diabetes, which is autoimmune. You may have another person that has rheumatoid arthritis, which is autoimmune, another person, another family has lupus, and then all of a sudden you’ve got the person sitting in front of you that has autoimmune thyroid condition and that particular case I’ve been able to glean from that history that my suspicion is higher that this person is going to have some subclinical hypothyroid issues, whether it’s related to autoimmune disorders or not.


16:06          Then I want to know from their family history, does anybody in your family have to take thyroid medication? If the answer’s yes, then I know it’s a really bad situation because I’ve just explained four scenarios telling you how it’s very difficult to get thyroid medication in the first place even when you need it, and my opening statement, I told you that there’s this huge debate on raising the limits and they raise the limits for a reason because it makes it just easier not to have to manage it. I mean, thyroid management is not difficult to me, but it can be difficult for some providers. Some medical providers, quite frankly, are a little bit gunshot. They’re a little bit skittish of managing it. So the bottom line is the whole pat on the back and being told everything is normal bulls down to the fact that hey, either a, I’m not comfortable managing this, or B, I’m just not quite sure how to interpret it, so I’m going to err on the side of what’s safe and not prescribed anything.


17:00          And the second scenario you run into, the medical provider makes the right diagnosis. Yeah, you need thyroid medication. They put you on thyroid medication, they recheck your levels and it’s like, oh my gosh, we got to back off the thyroid medication. Then they recheck your levels again after they backed off and all of a sudden it’s gone up and the TSH has gone up and it’s just this roller coaster effect for the patient. And then they get referred to a specialist and the specialist says, ah, you don’t really need the thyroid medication anyway. Just go ahead and stop it again. It just boils down to interpretability. How do you interpret these labs? What lab work are you ordering? If you’re not ordering the correct lab work, then you’re not going to have the correct picture. If you’re not spending time with the patient, with the client to take the history that should be taken, then you’re going to miss the, the diagnosis.


17:52          And unfortunately in this day of managed care and reimbursement from insurance companies going down every single year, I mean my last three years in clinical practice, I took a 40% reduction and reimbursement. Those are impossible odds. I don’t have uh, an MBA, I’m not an accountant, but I consider myself a fairly smart guy. And in my book that’s a failing business model. And I think that’s why we’re seeing clinics. And it used to be just family practice clinics or internal medicine clinics being gobbled up by hospital systems. Now they’re specialty clinics, surgery clinics, endocrinology clinics, ob Gyn clinics. They’re all being gobbled up by hospital systems. And then hospitals are gobbling up other hospitals, other smaller hospitals. And it boils down to the fact that it’s easier to buy things in bulk at reduced extremely reduced prices to reduce your overhead, to keep these services in play. And hospital systems know that as I’ve got an internal medicine clinic or family practice clinic out there that I have folded into my operation under my umbrella and I’ve taken over the management of that.


19:06          They know that even though it’s break-even or they’re losing money on the front end on those clinics paying salaries and all the overhead that goes with that, they know that they’re gonna make money on the back end because of the hospitalizations and things that they get. So that’s where we are in this day and age. And what that translates to with managed care companies, insurance companies, reducing reimbursement, forcing medical providers to see more patients per hour and hospital, huge hospital systems buying up clinics left and right and really turning down the screws so to speak, on the amount of volume that they have to see an a day and an hour. It just means less time for the patient. You’re not able to take as thorough of a history as you would like to. And I talked to my peers in the medical community and it’s not that they don’t want to do these things, it’s that they don’t have time to do these things.


20:00          Their hand is being forced in order to just eat out a a living so that that pulls us to scenario number three and in scenario number three, if you remember, this is a person who was very proactive on their own. They went to a forward-thinking medical clinic that got put on natural thyroid medication. Then they pop into their medical provider for their annual visit and the medical provider flips out thyroid medication. That’s natural as dangerous. It’s horrible stuff. You’ve got to get off of it. Actually, the research shows that levothyroxine and name brand thyroid medications, synthetic thyroid medications actually have more recalls from the food and Drug Administration. The natural thyroid medications. In fact, you can count on one hand the number of times that natural thyroid medications have been recalled. It’s double digits. The number of times that synthetic thyroid has been recalled. This is all public records.


20:57          You can check it out for yourself or you can read the book. I explained this in the book, but the FDA keeps public records and you can check it out. It’s there. It’s true information, so natural desiccated thyroid medication is actually some of the safest medication around. It gets a bad rap because it’s not a big pharma agenda drug that’s being pushed out there, but it’s a very good medication. I get excellent results with it. Scenario number four is the person who is typical failing bad brain fog, sad, no energy cold all the time. The list goes on and on and on. The medical provider does do a very thorough job at the history. They do a thorough job at checking the lab and then all of a sudden they realize, oh my gosh, this person has an autoimmune thyroid condition. What am I going to do?


21:47          I really not comfortable managing thyroid in the first place. I’m sure as heck not comfortable managing autoimmune thyroid. I’m going to refer them to a specialist and the specialist does kind of the pat on the back thing and says, you know, it’s autoimmune thyroid. There’s not much we can do for that. I’ll bring you back in three to six months. We’ll recheck some lab work and see how you’re doing then, but right now I’m not going to put you on any medication. That’s a tragedy because if there’s anybody that needs treatment for their thyroid condition more than anyone else, it’s that person that has autoimmune thyroid. This is the person that has been struggling for a very long time and they’ve probably been to multiple providers. They have tried their best to get the help and they’re fatigued. They’re tired of telling their story because they keep getting the proverbial door slammed in their face.


22:35          That’s the environment we live in. So what’s the solution? The solution is to work with somebody who thinks outside the box, work with somebody who is in functional medicine or integrative medicine, naturopathic medicine that can help you with your thyroid type issues, whether they be an auto-immune subclinical, hypothyroid or just full-blown the hypothyroidism. It’s important to get this treated for metabolic reasons in management of blood sugar for bone health, reasons for brain health, reasons for fat storage or reasons for just for energy and focus and concentration. And memory type issues, depression issues. It’s so important to get your thyroid treated. The brittle nails, the hair thinning, a feeling cold all the time. Those are just miserable symptoms. But their thermometers, if you will, telling us that, hey, there’s something going on in the body. And in many cases when you’re outside the box, in your treatment of thyroid, many cases you may find that there are times when everything’s normal.


23:38          When it comes to thyroid, it’s on the low end of normal, but a person has all the symptoms and all I say if it like a duck and quacks like a duck, guess what? It’s probably a duck. So when you get that thyroid treated, your energy is going to be better. Your brain fog is going to go away, your hair’s going to start growing again. Your nails are gonna stop being brutal. You’re not going to feel cold all the time. You’re probably going to start losing some weight. And that carries a lot of controversies because there’s one thyroid medication that says, can not be used for weight loss. Because back in the late seventies and eighties, it was being used for weight loss. Um, those people were probably subclinical hypothyroidism. Now that, don’t get me wrong, that medication, that particular medication, thyroid medication was being abused. But there are folks that have subclinical hypothyroidism that have steadily put on weight over decades and they get put on thyroid medication and they get their thyroid optimized, which is totally different than normalized.


24:36          They get their thyroid optimized and they start losing weight for the first time in decades. I mean, what’s wrong with that? Since when is though, uh, reversing obesity and weight issues a bad thing. As long as the blood pressure stable, the heart rate is stable, they’re not having any symptoms or side effects of anything else related to thyroid treatment, proceed forward. So that’s what you’re gonna feel like when you get the steroid condition taken care of. So those of you who’ve been following me for a while, know that I work with influencers, CEOs, entrepreneurs. I simply want to help them move from gray to extraordinary. I do this by crafting a custom-tailored wellness plan for them that helps them uncover hidden imbalances, helps them optimize for life, longevity and dominated to peak performance level. If you’re interested in working with me one on one, go to and click the link at the top of the page that says, “Work with Dr. B”, and fill out a really short application.


25:40          It’s 23 questions. Fill out that application and we’ll get back with you as soon as possible. If you’re interested in, again, in being on the list related to the book, and wanting to know when it comes out. Actually closer to time to the book launch, about 12 weeks before book launch, I’m actually going to be doing a series of Facebook live teachings, and Q&A surrounding the book. So, you’re not gonna want to miss that. Only people who actually go to and register, we’ll have early access to the book. We’ll have free access to the Kindle version of the book at the time of the launch, and we’ll have access to the private Facebook group. So, anyway, that’s all I’ve got for today. I’d like to thank you for joining me on today’s podcast episode. Please tune in next time. I’m going to continue this journey through the Happiness Hijackers book. We’re going to be talking. We’re going to be layering in more of these boxes that people get put into. Until next time, this is Dr. Brian Brown, the Optimal CEO signing off, and I hope you have an optimal day here


26:44          Here at The Optimal CEO Podcast, we help CEO entrepreneurs who love taking ownership of their wellness journey, but because they know it’s their most prized investment and when their state of wellness is at its peak, their income source. We want to help relieve CEO entrepreneurs from the pressure of unnecessary health exposure so they can be highly focused on growing their business and physically optimize for the journey so they can enjoy getting there


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