Graves’ disease is a complicated and often controversial condition to diagnose. This video explores the complexities of diagnosing Graves’ disease, the overlap with Hashimoto’s disease, and the challenges faced in distinguishing between the two. A blend of professional experience and an understanding of the current state of autoimmune thyroid disease diagnosis are brought together to provide insights into this multifaceted issue.
Martin P. Rutherford, DC
1175 Harvard Way
Reno, NV 89502
#drmartinrutherford #hashimotos #hashimotosdisease #drmartinrutherford
Power Health Rehab & Wellness
1175 Harvard Way
Reno, NV 89502
Power Health Chiropractic
1175 Harvard Way
Reno, NV 89502
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Okay, so I'm going to do this. This
is, how do you diagnose Graves? I don't know. No, I kind of don't know, and
I kind of do know, and I'll explain that. That's a tough one. Classically, Graves disease is
an autoimmune thyroid disease, as is Hashimoto's. The question that was asked regarding this was
a paragraph long, and I assume what it's about To follow is the reason why it was a paragraph
long, because I think it's still a gray area. I know if doctors watch me or they're looking
in, there's going to be a few doctors that are Going to dispute what I say. There's going to be
a few doctors that are going to say, "You're a Quack," or whatever it is, but I know what I
see. I've been doing this for a long time. I'll Just share with you my experience on it because
I see probably 12 or 15 Graves patients a year, Which is a lot for my practice. I do mostly
Hashimoto's, I do chronic diseases. I do Mostly autoimmune stroke, [inaudible 00:01:07],
Lupus, Crohn's, all that type of stuff. Graves is Nowhere near as prevalent as Hashimoto's disease.
I don't know what the actual ratios are, but it's Significant, 50 to one or 40 to one. Now,
don't take me… I'm just saying it's a lot, A lot of Hashimoto's versus maybe one
Graves thing. I don't see a ton of them In general, and they have unique characteristics. I think maybe where this question's coming from
is because of some of the things that I struggle With in trying to figure out is this a Graves
patient? Graves disease, it's hyperthyroid. Well, okay, some people have a unique diagnosis
for hypothyroid as well. It's an immune attack Against something called your thyroid stimulating
hormone receptor sites. These are the sites on Your thyroid that when your pituitary
gland sends thyroid stimulating hormone To your thyroid, it has to go into the tissues
through receptor sites. When these guys become Super sensitive to the thyroid stimulating
hormone, you start getting hyper symptoms. A Graves patient, classic thing is they usually
start off with anxiety for no reason at all, Maybe even to the level of panic
attacks. They'll start getting jittery, They'll start getting heart palpitations, they'll
start getting sweatiness, maybe sweaty palms, Maybe just sweatiness in general, this low
level of anxiety. That's in the beginning. Then at some point in time, maybe you go to
the doctor and then the doctor, somebody goes, Finally, they go, "Well, we've checked everything
else, it's not your heart, it's not this, and it's Not that." Maybe check your thyroid. Then the TSH
stimulating receptor antibodies come up positive. That's the gold standard for diagnosing
Graves, except that person's usually thin, That person usually has no energy,
that person usually can't sleep. Then I have a person sitting in front of me here
who has positive TSH receptor antibodies, has been Definitively diagnosed with Graves. Some have had
their thyroids taken out, some them have had them Radiated. Some them are just taking Methimazole
but they're sitting in front… well
Strike the Methimazole because Methimazole will do
exactly to the person what I'm about to describe. They're sitting in front of me and
they're way overweight. They're fatigued. They have constipation. Their skin's getting dry.
That's not a Graves patient is usually going to Be thin, they're never going to be able to go
to sleep. They're going to have tons of energy, More energy than they want to have.
You have look at that patient and go, Hashimoto's thyroid disease, you test for thyroid
TPO antibodies, thyroid peroxide antibodies that Actually make thyroid hormone. This is different.
You test for antithyroid globulin antibodies. Those are antibodies that attack the actual tissue
of the thyroid. The thyroid peroxidase antibodies Actually attack enzymes that make the thyroid
hormone and the TSH antibodies are different. TSH, Graves. The other two, Hashimoto's.
If all three of them come up positive, it's more Or less accepted today when people run all three
of them, it's more or less accepted today that That means that you have graves. But again, I have
that person come in and they have all the symptoms Of Hashimoto's including being overweight,
and their hair is falling out, and they have Constipation. They have all the hypo symptoms
and intermittently have the hyper symptoms, But because the TSH antibodies are the thyroid
stimulating hormone receptor site antibodies, Graves, are up, they get diagnosed
at Graves. They don't have any of The clinical findings of Graves. They have
all the clinical findings of Hashimoto's. Now, fortunately, it doesn't change treatment
a lot if you're in an office like mine, because They're both autoimmune diseases and you treat the
autoimmune disease first. But in a medical office, It's going to consequences, because in a medical
office, they're going to take your thyroid out, Which may be the right thing to do if you
have Graves, depending on how severe it is And so on and so forth. I'm not arguing that,
or they're going to give you Methimazole, Which is then going to put you into hypothyroid.
Methimazole is going to stop your thyroid from Getting the thyroid stimulating hormone, and
then you're going to go into hypothyroid, And then maybe you put on weight.
More confusion, but now maybe you start looking at The hypothyroid patient. Maybe not so confusing,
because if a person comes into me like that and They're on Methimazole and they're overweight
and they're hypothyroid and they're fatigue, Well, that makes sense because they're blocking
your thyroid from making thyroid hormones at that Point in time. I hope this isn't getting too in
the weeds. The bottom line is, to me also, okay, I'm in the autoimmune world and my understanding,
and I have colleagues who are immunologists, I have a colleague who's an immunologist, and
I have another colleague who teaches a lot Of these things who's, he's doing research at
Harvard on autoimmunity relative to thyroids. This particular set of colleagues is
of the opinion that the ability to Diagnose autoimmunity is still in its evolution.
I have people come in here all the time and they
Go, "Well, my anti-nuclear antibody is
positive, but the doctor said it doesn't Mean anything." An anti-nuclear antibody is
a catchall in some ways. It can indicate, Show [inaudible 00:07:48], it can indicate Lupus.
I'm using this as an example. It can indicate all Those things if it comes up positive that you
should look for those. But the doctors will say, "Well, it's positive, but it doesn't really mean
anything." Well, anti-nuclear antibodies means That you could be getting an immune attack
against any cell in your body, so I think it means Something. My question to them is, well, what did
you run a test for if it was coming out positive And you're saying it doesn't mean anything?
I'm stating that to state the general confusion Of diagnosing autoimmune diseases relative to,
oh yeah, your antibodies are up so that's it. I know there is a lot of things that
can increase antibodies. I'm way more Familiar and more confident with Hashimoto's
diagnoses because there's a ton of things that Can make those antibodies go up and down
like that in a day. Being too sedentary, Doing too much, eating salt, so and so forth.
I have to assume because of the results that We've seen with Graves disease, that is the same
with them. If you go in and you have positive TSH antibodies, to me, you need to go further,
and especially if the person's not classic, if The person's not Marty Feldman, for those of you
who are younger, Marty Feldman was a comedian who Was in a lot of funny movies, and he had bulged
eyes. That's the classic that people think about With Graves. That happens way late, but unless
you're like him, super hyperactive and you have The [inaudible 00:09:32], you have the eyes and
so on and so forth, and you have the antibodies, And you're thin and your hyper and you have
all those signs, then okay, you're Graves. But after that, I think it gets,
for me, and studying with people who Supposed to know this stuff being an immunology
field and studying autoimmune thyroid disease At Harvard, it's still a little bit of a gray
area because it's not definitive as to how you Diagnose autoimmune disease. To me, the next
step is to either do a diagnostic ultrasound And there's a certain presentation there that may
present itself that may give you a little bit more Data. Do a doppler, which will tell you about
the vascularity of it. Look at the person. If The person's sitting in front of you and they have
positive TSH antibodies, TSH receptor antibodies, But they're not on Methimazole, which is from the
hypothyroid, and they're classically hypothyroid, I'm going with Hashimoto's, especially if the
Hashimoto's stimulating antibodies are up. There's all kinds of variations on that. You can
have, I've seen where the Graves antibodies are Up, the Hashimoto's antibodies are down,
and the person is full-blown Hashimoto's From an exam and a clinical perspective of they're
overweight and they're tired and they're fatigued, And so on and so forth. You see all these patterns
coming in. In the medical world, it's the Graves Antibodies are up, you have Grave's disease. I
don't think it's that basic, just based on, again,
I've been looking at Graves patients probably
since around 2018, and I've seen a lot of them Relative to having done it for that while.
I've talked to colleagues of mine about this, And I seem to get the same confusion when I'm
talking about this. My colleagues, most of my Colleagues are not in the medical field. Most
of them are in the alternative field, and we're Trying to figure out how to dampen these.
Now, here's the good part. The good part is It's an autoimmune problem, and it can be
treated. It can be treated alternatively, Although it's a little tricky. You have to
be a little bit more careful if the person Has Graves disease, because the whole thing
is, if the person does have Graves disease, They get an attack, they go into a thyroid
storm, the heart starts beating and it blows up, That's not a good thing. That is a possibility
when you're dealing with people. I don't have a Problem with treating people when they're on
Methimazole or if they've had their thyroid Radiated or if they had their thyroid taken out,
because a lot of them still have symptoms because Sometimes you don't get the whole thyroid out.
It's still an autoimmune disease. It's still an Autoimmune disease, and there's a lot you can
do to dampen it and control it, sometimes with Alternative autoimmune procedures, sometimes with
using the same approach that you would use on Hashimoto's, but maybe hedging your bets by taking
the Methimazole, and if you're getting rid of all Of the triggers, then you may be able to take a
lower dose of Methimazole and not be thrown in The hypothyroid. It's a complex situation. When I
get a Graves patient on my consult sheet, I just Take a deep breath and go, do I still want to keep
doing this? But the answer is yes, relative to, It's in our purview, but you
have to really think about this. To the person who asked this, it's not as
clear as I have positive thyroid stimulating Receptor antibodies. If you do, and you're
thinking through it as a clinician, certainly Your first, on the top of your differential
diagnosis is going to be Graves. But look, Follow up. If it doesn't look right, if it has
a weird feel to it, okay, I know they're up, But this doesn't feel like a Graves patient
in any way, shape or form. Do the ultrasound, Order the ultrasound, order the Doppler. Look
at them. See if their other antibodies are up. Maybe hedge your bets and pull all
the triggers for Hashimoto's as Well as treating them for Grave's disease.
In my world, I'm using herbs and botanicals And diet and lifestyle and things of that
nature. Pulling a couple of extra foods out of There isn't this big, drastic thing as if I was
giving a different drug or something like that. That's my dilemma. Now, maybe there are people out
there who got Graves disease down like that. If There is, then I would like to meet them, because
I know some really heavyweights in this area of Diagnostic and treatment, and I happen to know
that they flail a little bit in this area as well, Because I just think the definity of the
diagnostic protocols for this is not yet set.
It's my opinion. This is an opinion based on
what I've seen, so don't yell at me. If you're A doctor, don't call me a quack or whatever.
Or you can call me a quack, that's fine. That's what I know on Grave's
disease and its diagnosis.