How To Diagnose Graves’ Disease
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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
775 329-4402
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Power Health Rehab & Wellness
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Reno, NV 89502,-119.785944,15z/data=!4m5!3m4!1s0x0:0x90d76a4cde7e869f!8m2!3d39.513406!4d-119.785944

Power Health Chiropractic
1175 Harvard Way
Reno, NV 89502,-119.7860145,15z/data=!4m5!3m4!1s0x0:0x7b7ea11e51d896cb!8m2!3d39.5131351!4d-119.7860145

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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.