On 25th May 2023 we held a webinar for World thyroid Day which included excellent presentations by:
Dr Nirusa Kumaran – Genetic Changes to be Aware of for Thyroid Disorders
Virginia Blake, Nutritionist, Regenerus Laboratories – Optimising Conversion of inactive T4 to active T3: Testing and Nutrition Considerations
Prof Catia Montagna, Chair of Political Economy at the University of Aberdeen – Wellbeing and Labour Market Implications of Thyroid Dysfunctions – An Analysis of People’s Experience with Thyroid Disease Survey
Rachel Hill – Author and Thyroid Patient Advocate
Perfect um so I am Dr Nisha kiman um I’m a GP um I’m also a certified lifestyle medicine physician um and a functional medicine doctor um and so today um I’m going to be doing a presentation about the genetic changes to be aware about for thyroid disorders um so I’m also a
Trained uh nutrigenomics practitioner with um a provider called life code GX so um most of the talk today is kind going to be referencing to their panel that they provide um so I myself also have Hashimoto um thyroiditis um I was diagnosed in 2016 so for me as well this
Has been an interesting Journey um the last few years kind of understanding um thyroid disease um and really kind of developing my expertise in this um and really to try and get to the root causes for why thyroid disorders developed rather than the current kind of conventional approach of just um you
Know taking Levi thyroxine and that being that you know really to try and understand what the triggers are um and really that’s kind of furthered my interest in understanding the genetics regarding um thyroid disorders as well um so sorry I’m just trying to move right so
Um as you know uh thyroid disorders are very common um it’s estimated that one in 20 people have a thyroid problem and probably more because many people are um undiagnosed or um unaware that they may have a thyroid problem and there’s often many triggers for why a thyroid problem
Can occur so things like lifestyle factors nutrition diet stress environmental factors all of these things things can predispose you to developing um a thyroid condition but often there will be an underlying genetic factor that will have um triggered or have be the underlying predisposing Factor um which then
Enables the further triggers to then trigger a thyroid condition so what are epigenetics so epigenetics is this the um way that the environment affects our genes so it’s essentially the study of how our behaviors and environment can cause changes in the way that our genes work now it’s really important to know that
Epigenetic changes are reversible so you know it’s they’re not kind of lifelong so if you have an epigenetic change it’s not kind of a life sentence you can modify your diet your lifestyle to enable these uh genes to then fun function effectively so how do these epigenetic
Changes occur they occur by what we call single nucleotide polymorphisms so so so snip so these are changes that can happen in a single DNA building block um which can result in a change in gene expression and function so nutriomics is the study of how nutrition can affect
Genes so it’s how nutrition impacts these um epigenetic changes and causes these Snips so as we know poor lifestyle poor nutrition can cause these Snips to develop but then you can reverse these Snips by adopting um a good nutrition um and optimizing your nutrients so um this is this the an
Example of the testing that um uh I can offer with life code GX so as you can see we can assess for a various kind of a large number of different genetic changes in the um kind of the whole thyroid axis so as we know in terms of
Thyroid physiology um there’s kind of a series of steps that need to occur for thyroid production thyroid metabolism thyroid activation um I’ll talk about that briefly in a second but there’s many many different genes that can be affected at all the the various different stages of the thyroid Pathways
Um and so in some people you may only have a few genetic influences some people may have many but it’s interesting to know because then you can look at how your nutrition and how your lifestyle can then be modified to improve these genetic snits so in terms of thyroid physiology
Then so um you know just to kind of recap on thyroid physiology um so in terms of how the thyroid is um kind of produced how thyroid hormone is produced we have initially we have a hormone that’s releas relased by the brain called the thyrotropin releasing hormone
Which is released by the hypothalamus to Signal the pituitary gland to produce TSH or thyroid stimulating hormon this TSH then signals the thyroid gland to produce thyroid hormones um mainly T4 T3 and reverse T3 um and then in in the thyroid gland itself we know that the
TPO Gene so the thyroid peroxidase um Gene oxidizes iodide into iodine which then can uh essentially with the help of hydrogen peroxide it basically joins tyrosine residue so tyrosine is a protein it’s an amino acid it’s a really important amino acid for thyroid hormones um and tyrosine basically um
Joins with IOD iodine to make T4 T3 and reverse T3 um and then in terms of clearing X is hydrogen peroxide because we know that hydrogen peroxide can be damaging to the thyroid gland we need a gene called glutathion peroxidase to essentially remove hydrogen peroxide from the thyroid gland otherwise that in itself
Can be quite damaging to the thyroid gland there’s then a negative feedback loop so what T4 T3 reverse T3 can essentially do a negative feedback FL but back to the hypothalamus and the Petry to essentially say either produce more or produce less thyroid hormone depending on how much thyroid itself is
Being produced now also important for um thyroid function are what we call deiodinase enzymes so deiodinase enzymes have various different functions in thyroid metabolism and thyroid production um and there’s three main types of deonas enzyme so there’s the dio1 which can convert T4 into T3 in the thyroid gland there’s dio2 which
Converts T4 to T3 in the thyroid gland and in the peripheral tissues and there’s Di 3 which converts T4 to reverse T3 and these it’s important to know that these are all selenium dependent enzymes so as we know T3 is probably one of the most important thyroid hormones
Because it’s what our mitochondria need to produce energy so our mitochondria are the energy centers of all our cells um it’s pretty there we know we have mitochondria in pretty much every single cell of our body except our red blood cells and essentially mitochondria are needed to produce ATP our main source of
Energy and so for our mitochondria to function effectively we need optimal levels of T3 yet most of the thyroid hormone produced by a thyroid gland is T4 so essentially our body needs to have good function of these deonate enzymes to be able to convert the T T4 into T3
As without that conversion happening you can’t utilize that T3 to then produce energy and get our mitochondria to function well um likewise T4 can also be converted to T reverse T3 which is not utilized so we can’t use reverse T3 to produce energy um and so you know we do
Need to be mindful because you know certain things can actually favor the conversion of T4 to reverse T3 and that’s things like extreme stress illness um and other kind of life star factors um and so again this is where the genes is really important because you know genetic variations on these
Deonas enzyme genes can also affect how these um genes are working um and then so what happens in autoimmunity so as we know autoimmune thyroid conditions kind of are the most prevalent type of thyroid conditions present so we know that autoimmunity happens when there’s a disregulation
Ation of the immune system leading to an immune attack on the thyroid gland so this is where we can get antibodies that develop to the thyroid itself so typically we see antibodies to the thyroid peroxidase and also to thyroglobulin which is a protein in the thyroid gland um so when these
Autoimmune Auto antibodies develop we can get chronic inflammation of the thyroid gland also known as thyroiditis so this then causes tissue damage and disruption of thyroid function so there’s obviously there’s two main types of autoimmune diseases is Graves disease and Hashimoto Graves predominantly presenting as hyperthyroidism and Hashimoto predominantly presenting as
Hypothyroidism underactive thyro thyroid um and it’s also important to know that often there’s genetic variants that are the primary risk factors for the development of an autoimmune thyroid disease so you can see often there’s a strong family history component with autoimmune thyroid conditions so now I’ll go through the relevant kind of
Genes to be um to be aware about in each of the different stages of the thyroid um physiology so when we look at the actual hypothalamus pituitary thyroid axis there’s three main genes that we can test for so there’s um C A ZB pde a
TS HR so the capap ZB Gene this codes for the production of TSH from the patory and changes in this Gene can cause either increased or decreased thyroid stimulating hormone production for pde8 so Snips in this Gene can increase or decrease thyroid sensitivity to the gsh so if it’s lowered so if the
The sensitivity to TSH is lowered it will inevitably lead to to lower T4 and T3 production now it’s also important to know as I mentioned as these are epigenetic changes these can be modified with lifestyle and nutrition so AR choke and ginger can be quite helpful in this
Case to increase sensitivity to TSH in the thyroid gland then there’s the tshr gene which essentially um can affect the TSH receptors um on the thyroid gland and so in some people as well you can get antibodies to the TSH receptors themselves that’s very rare that’s probably the least common type of
Autoimmune process that can happen but ultimately that’s what often kind of in terms of grav disease that’s the main kind of pathophysiological process it’s the development of tshr antibodies and in order to support that you’ll be thinking about anti-inflammatory nutrients and vitamin D then looking at the actual genes at
The in the thyroid gland itself so you have the thyroglobulin protein so the thyroglobulin the gene that codes for that so again if there genetic changes on this Gene you’ll have an increased risk of developing an autoimmune thyroid condition um and this is exacerbated in
The presence of what we call HL a d R3 alyss so these again are certain genetic changes that can predispose you to the to the development of celiac disease or gluten sensitivity um and then um the thyroid as you know the thyroid globulin that protein it actually provides tyrosine
For thyroid hormone synthesis to then enable the storage and and inactivation of thyroid hormone and iodine so again thyroglobulin is a really important protein for thyroid hormone synthesis so in in cases where if you’ve got genetic changes with the thyroid globulin Gene you can you may need to avoid iodine
Because actually iodine in excess in autoimmune patients can be harmful to the thyroid gland so again just you know you need to be really cautious when you are if you are thinking about supplementing iene and also this is where a gluten-free diet can be really helpful for patients with um thyroid
Disorders the other Gene to be aware about is G gpx1 so again Snips in this Gene can increase the risk of oxidative stress or oxidative damage to the cells increasing autoimmunity so oxidative stress is a a process that happens when again if our mitochondria are not functioning very well we produce these
Free radical species and these free radicals can be harmful to our cells creating a process called oxidative stress and so how we can help support this is through giving selenium and then aiding with detoxification to remove these free radicals um and there’s our Master antioxidant or detoxifier in our
Body called glutathione and in order to help synthesize glutathion we can consider glutathion rich foods and glutathion precures such as n acet cine um and then there’s the Snips to consider for thyroid transport so in this case um we’ll be looking as two main genes so that can affect how the
Kind of um thyroid hormone is then transported from the thyroid gland to the tissues so again if there’s any issues which you know this is where it’s becomes quite interesting because your thyroid could potentially look normal on your blood test because your thyroid is you know your thyroid gland is producing
Thyroid you’re producing T4 T3 and so you’re not you’re not seeing that kind of result you’re seeing a normal result on your blood test but if you’ve got then issues with thyroid transport and how your peripheral tissue are able to utilize thyroid then um that may not
Necessarily show up on a blood test again this is where genetic testing can be quite helpful so with as I mentioned so with these genes so if you’ve got changes in these genes if you you know if thyroid transport is affected then if you’re not transporting your thyroid to
Your cells and your tissues and your cells and tissues are not able to utilize thyroid hormone and that’s where majority of the symptoms of hyperthyroidism can develop um and this is particularly important for brain health because you know if the thyroid hormone is not being transported into
The brain then we’re you know increasing risk of mental health conditions um and then looking at thyroid Activation so once the thyroid is transported you need to activate the thyroid so as I mentioned there’s the deiodinase enzymes that can activate the thyroid so particularly through the T4
To T3 conversion as I mentioned these genes are selenium dependent so if you’ve got changes in these genes supporting selenium is very important and then there’s also um vitamin D so vitamin D again is extremely important for thyroid activation and so if you’ve got any changes to kind of your vitamin
D D genes then that can also affect T3 activity so vitamin D is a really important nutrient to support um and then for thyroid metabolism so this is how the thyroid is then kind of metabolized and excreted out from the body so through detoxification so again Snips and these
Genes can affect how the thyroid is essentially detoxified um and so in these things if you’ve got genetic changes with your detoxification processes um addressing your detoxification with detoxification supporting Foods so particularly things like sulfur that are found in garlic onions and leaks is important and then also looking at gut
Health and disbiosis so we know that um especially for a process called glucuronidation um the your your gut health is extremely important um and we know that in cases where there’s disbiosis that process of glucoronidation which is a detoxification process can be affected so um again when we often find in
Patients with thyroid disease that gut health is one of the main like poor gut health is one of the main kind of triggering factors for then the development of thyroid disease so from a functional medicine approach um g health is often kind of one of the main areas
That we will look at um for patients presenting with thyroid conditions um and then lastly looking at the the Snips for autoimmunity so there are several gen that can predispose you to developing an autoimmune thyroid condition um and often when there there’s a genetic change in this um as I
Mentioned it will increase the risk of developing antibodies so particularly there’s the C4 um and this is a group of genes that regulate the immune system so any changes in these genes can lead to loss of immune regulation increasing risk of immunity there’s the foxy1 gene um and
Then this Gene is responsible for thyroid devel velopment so changes in these genes can affect the thyroglobulin and thyroid thyroid peroxidase um antibodies um so again increase the risk of developing antibodies to the thyroglobulin and thyroperoxidase and then as I mentioned there’s the HLA uh genes so these genes can affect how
Antigens or kind of peptides are presented to the immune system so um as I mentioned gluten can often be a trigger for thyroid conditions the reason being is that the gluten protein is very simil SAR to the thyroid protein and so where um our body can produce
Antibodies to gluten um we can mistaken the thyroid gland for gluten and start producing antibodies to the thyroid gland itself and so often following a gluten-free diet can be quite helpful for those with um thyroid conditions so in terms of how to kind of just to kind of summarize how can we
Support our thyroid health from a kind of epigenetic point of view so you know it’s really important to know that yes these epigenetic changes can occur but they are modifiable they’re reversible and just because you have a genetic predisposition that’s not technically um you know a live sentence so you know
From a functional medicine approach we’re always looking at the root causes and the triggering events for why these thyroid of why a thyroid condition may have developed so in terms of how we can support the thyroid um we’ll be looking at dietary triggers and the most common
As I mentioned being gluten dairy can also be a very common trigger for some people for the development of thyroid disease um and so some people find that doing something called a full autoimmune protocol diet can be very helpful for identifying food triggers so this is where you eliminate or kind of common
Food triggers for thyroid disease or autoimmune thyroid disease for a period of 4 weeks sometimes longer and then you introduce Foods back one at a time to see what are your specific food triggers um and then ensuring that you have sufficient thyroid supporting nutrients in your diet or you know if you’re
Taking supplements so selenium so to optimize selenium you should um you know taking two Brazil nuts a day so eating two Brazil nuts a day can give you the required um selenium that you need magnesium zinc vitamin D these are all really important nutrients to support thyroid Health um I mentioned being
Cautious with iodine especially in the context of autoimmune disease yes a little bit of iodine is needed but excess iodine is harmful if you’ve got autoimmune thyroid disease so just be careful because a lot of thyroid supporting supplements will have iodine in them um and then essentially really
Focusing on having a Whole Food’s anti-inflammatory diet so looking at ways of you know removing refined Foods removing refined carbohydrates removing processed foods sugars and really encouraging whole grains um proteins healthy fats like um avocados nuts and seeds oily fish um and really looking at ways to support your um kind of thyroid
And your overall inflammation through um a whole food anti-inflammatory diet I mentioned avoiding iodine in excess and then really to look at the body as a whole so really you know your thyroid is just you know rather than focusing just on the thyroid gland the thyroid kind of
The effects of the thyroid are systemic the thyroid is literally um T3 as I mentioned you literally need it for every single cell and every single organ and tissue of your body so you really do need to start looking at the body as a whole to figure out what what else is
Going on here like what else could be triggering this thyroid disease disas so as I mentioned you know it may not be the thyroid gland itself it could be an issue with thyroid transport it could be an issue with the peripheral utilization of thyroid hormone so you know we know
As I mentioned things like stress um infections poor gut health toxins um these can all affect thyroid hormone um production activation and how we can utilize thyroid hormone so um in summary you know the key points that I would like you to take away from from this talk are that epigenetics are
Modifiable you know your genes can load the gun but it’s the lifestyle that pulls the trigger so really to try and look for the root causes for why your um thyroid condition may have developed and to look at everything as a whole rather than focusing in on kind of just genes
Itself or on the thyroid itself so thank you for listening today if you would like to work with me for functional medicine I’m currently working with Dr Sarah Davies who’s a leading functional medicine practitioner in the UK we um at a clinical functional Nexus we um just to note we also do have
An endocrinologist on our team who is prescribing uh T3 for anyone who’s interested um but we any patients that come to see us will be offered a full functional medicine approach to their thyroid so um I will leave it there thank you very much thank you narusa thank you so much that
Was really interesting um I think at the moment we’ve got just one hand up or two hands up um Lou just need to Elsa do you have a question sorry Elsa you’re we can’t hear hear you yet I’ve clicked disabled mic but it doesn’t seem to be doing it
So I’ve allowed it now it needs to be allowed so I’ve done that so Elsa are you there do you have a question can you put your mic on is your mic on Elsa okay can you hear me now yes sorry sorry I didn’t realize yes basically I was saying I’ve been
Diagnosed with hypothyroidism about 31 years ago and the Endo endocrinologist put me on 100 um milligram of Levothyroxine which I’ve been taking for a very long time um with my same GP you know I’ve had the same GP for 27 years then like three years ago
My GP U just um closed you know he stopped practicing and I had a new GP and through blood test and all that they said that my 100 m milligrams was far too was too high basically because on the on the paper the results of the blood test
Showed that it was too high I was feeling tired all the time at the time but after that we discovered that I had no vitamin D whatsoever in my system um so they They carried out the doctors They carried out um various tests like um at first they put me for three days
On um 70 milligrams of Lebo thyroxine all those sort of changes but I’ve never felt that well so now I’m back on 100 milligram and I’m I’m okay now but the paper says that it’s too high so shall I carry on like this or shall I go back to all them trials I
Don’t want to do that because I was feeling really unwell when I was on 70 milligrams of levothyroxin that just didn’t work for me I’m really sorry I can’t give any personal medical advice because you’re not my patient but kind of generally kind of if you presented so
You know be thinking about peripheral uptake of your thyroid hormone how yourselves are managing to utilize that thyroid hormone so it sounds like you need a higher dose of T4 because you’re not converting that T4 into T3 sufficiently and so you’re needing that higher dose of T4 to enable to you to
Get the T3 but as I mentioned your blood thyroid panel is not a reflective of what’s happening in your tissues per se so yes because your blood test shows your TSH is suppressed it doesn’t necessarily reflect how your tissues are getting the thyroid hormone so working
On that T4 to T3 conversion is going to be really important so looking at nutrition in terms of selenium support um and then other kind of nutrients that can help with that T4 to T3 conversion is going to be really important can I just say can you hear me
Just checking um can I just say that we hear this a lot we have a lot of people come to us who say their TSH is low and my doctor has reduced my Leo thyoxin um all I can suggest really is just to go back to him and say look I’m not very
Well on this could you please put up again I mean he may do another test and find that your TSH has raised a little bit because you’re on that um but really you do need to go back to your GP and just say could I please go back I’m so
Poorly now I need to go back onto that dosage because I felt so well on that dosage yeah in fact now I’m back on 100 and I’m fine I’m just yeah taking it a vitamin D as well um yeah definitely vitamin D which really helps and so many
People in the UK are low in vitamin D and they don’t realize they just don’t realize we definitely need it all through the winter here but I know a lot of people need it all year round I have to take it all year round otherwise I
Get very low levels of vitamin D and then you feel exhausted and tired yes yeah so I’m fine now okay good good good um who else uh so Lou if you could turn that mic off and Caroline I think is next right no no no oh number seven wow
It’s Mary Mary S is next um so Mary if you can turn on your microphone you should be able to speak now hello can you hear me yes thanks for the presentation is it nusa yeah um yeah thank you it’s um quite interesting because you mentioned a lot of um Snips
Really that can affect a thyroid and it’s quite refreshing to find someone who actually um knows so much about the all of those because you know most GPS think that thyroids disorders are straightforward um very simply sorted by a TSH and and very little else and
Um you know and and they they diagnose and treat by that and refuse to refer you because they don’t know that there’s more going on um I have confirmed uh dio1 and dio2 Snips um you seem to be saying which I hadn’t heard before that
That can be reversed is is that right by by diet nut I mean I have I what I think is a healthy diet I eat nuts I eat avocado you know I eat a wide variety of things mainly Whole Foods don’t eat much um processed food um cook from scratch
Um and you know and I’ve been doing that for a long long time um but I still seem to need T4 T3 um so I’m intrigued really by what you’re saying because that’s that’s new to me uh and it doesn’t really kind of fit with my experience unless there
Something else going on of course it’s h as you know it’s very complex so um with there could be kind of you know multiple genetic changes happening um so it may not just be the di1 and dio2 snip that are contributing to your need for T3 so um I wouldn’t
Only like my focus wouldn’t only be on the dio1 and dio2 I’d be trying to look at all the kind of genes in context um and um yes absolutely these um epigenetic changes are modifiable to an extent but it’s not going to be the case for everybody unfortunately so you know
You know certainly my Approach would be to try and optimize your nutrition and lifestyle the modifi modifi modifiable factors that can affect your epigenetics but once you’ve done that and if there’s still a conversion issue I would 100% support T3 therapy that’s it’s needed um
And you know it’s really to try and look at kind of all the factors um rather than you know I’d say um the concern I suppose is you know if you look you know if you go straight to T3 therapy without kind of optimizing your health your diet
Your nutrition and everything else like that that T3 again it might not be effective you might not be able to utilize that T3 very well if you’ve still not been able to change the underlying kind of you know your kind of Lifestyle Etc so um so really is to
Improve the efficacy of that T3 therapy that these kind of Lifestyle Changes are really important as well yeah okay I I say my experience um there may be something else that I don’t know about because obviously doctors don’t readily test for all the things that might be going on
Like um different nutrients um or minerals that I I might I mean I supplement B12 complex and and D3 uh with MK2 so you know and then with my diet which as I said I’ve been on for for years but um at the moment you know still needing
That but it may be that there’s something undiscovered because you mentioned quite a few Snips that I have no idea if I have those but it it’s so frustrating um that that you as someone who you know suffers from a thyroid issue yourself can can you know obviously um
Impart the knowledge that you have on these things and yet it’s not widely known in the general endocrine community in the NHS and it’s so hard to get any recognition for you know I mean people ask sometimes on on the the Sor support group is it worth me getting a dio2 test
I think I might you know have an issue that and you don’t really know whether to say yes it should be yeah a resounding yes you need to know that so that you can address it but but really the truth is is there a point because even if people have a certificate that
Says they have it and that it affects ft4 to T3 compersion going to see a GP and saying refer me to an endocrinologist please I’ve got an issue just might fall on deaf ears so I’m beginning to rant now but you’ve answered my my question but thank you very much it’s very interesting
Thank you Mary I’m going to turn your mic off now um Tabitha if you can turn your microphone on and ask your question hi um hi okay so um I’ve been having I started having issues when I hit the menopause I was about I say about almost
48 um noticed a huge difference in how I felt I’m somebody that’s always worked out eaten healthy blah blah blah I’m now 50 three this weekend and I’ve just found out that although my thyroid is seems to be fluctuating uh it’s kind of range from about
450 to 575 I think is the highest has been right so my TSH has been doing this I think I’m subclinical hypothyroid is uh hypo hypothyroid but um secondary to that I had pneumonia last year then I seem to develop a chronic cough after that that I suffered from months and months and
Months then from going to the doctor’s and then decided to go private to get to the bottom of it I found that my thyroid has actually not my greater anywhere it’s inside my tongue and that’s become a Goa so I have two very large masses I
They think it’s one big Mass but it’s turned out that I’ve got no thyroid here and it’s all inside my tongue on the base of my tongue so that’s what this is here that’s the one underneath in the midline jaw and I’ve got one on the actual inside of the base of my
Tongue so I’m convinced I’m hypo thyroid I just wanted to know what you thought with those levels of TSH and the fact that I have a very large guer and where it is yeah so optimal optimal TSH that we aim for in the clinic is less than um it’s between two
To 2.5 that’s the optimal TSH so certainly if you presented to us that would be that considered hypothyroid um oh right okay yeah yeah um but yeah it’s very have not met anyone before that has um had an issue with a thyroid migration you probably obviously had that since birth and not
Only just come to realize yeah yeah yeah it’s it’s caused it’s caused such a big issue I’m actually off on the sick at the moment I’ve been off sick since January I’m very lucky I have very supportive employers um and because I’m a trainer I
Deliver courses is just I can talk for a while and then I’ll start coughing cough cough cough and then by the end of the day coughing all night and then it’s just constant it was just literally Relentless um when I saw the surgeon he said if I have the surgery to remove it
Because that was the initial thought it would have to be removed um I would lose most of my tongue and I just end up with a hole of my neck and limited speech so as you can imagine I’m scared um so I’ve now looked into uh I had a little chat with the
Radiologist that did the ultrasound um and he seems to think radio frequency ablation might work for me are you familiar with that no unfortunately not all right okay but it does sound like you do need some thorough support in terms of some thyroid moment potentially because you
Know without that that go is going to enlarge and cause further issues in terms of respiratory um issues so I would recommend looking into potentially trying to Source you know a thyroid hormone um either through your GP or privately okay so what did you say the
What did you say the a normal thyroid thing was the range the TSH so ideally we would like to see it around 22.5 um obviously too low TSH isn’t good either because suppressed TSH you know does you know there is kind of evidence to show that that can increase your risk of
Cardiovascular disease and osteoporosis so you we do need to have there had to be kind of an optimal range of TSH you know I would be happy to see it anywhere between 1 to 2.5 um so yeah okay thank you okay I’m really sorry but we have to
Stop there um for those of you that still have questions could you please put them in the chat um and we’ll we’ll ask narusa the questions and get back to you um so it’s time for a break now and thank you so much narusa that was really really interesting and I’m sure
Everybody found it interesting as well I mean I I’ve known that there are other Snips but that was an explanation of it that um was quite simple compared to some of the research papers that I’ve read so um so thank you so much for joining us yeah it’s it’s been a
Pleasure to be here okay so we’re going to come back at 12:35 um give you all chance to uh have a comfort break and perhaps um something to eat quickly um and I I’ll see you then thank you okay so I’ll tell you very quickly a
Little bit about my background I am a clinical nutritionist and I also have hashimotos I’ve had it since my early 20s and I’m now 49 um so I’ve always been very interested in the condition and what we can do nutritionally to support it um I
Read a book when I was first ill which was like you don’t have to be unwell and I thought well that’s a very interesting concept what can I do to improve my outcomes I also um have lectured in the past I run a clinic and I work for
Regeneris labs where um I provide clinical support to practitioners and also people who take the di2 test so that’s a little bit about my background I’m going to talk about how T4 is produced now Dr um Karan covered some of that so I’m not going to spend
Too long on it I’m going to talk about conversion to T3 I’m going to consider um dio2 which Dr ciman mentioned um around the genetic factors affecting conversion I’m going to explore nutritional factors affecting conversion and and some General Nutrition recommendations in thyroid disease um the GP who was just
Speaking was talking about how you need to be careful with supplementation and dosages and that’s particularly true with the thyroid because as you guys all know it’s an incredibly fussy little gland that requires personalized management so um this is the Cascade of thyroid hormone production and the part that I’m particularly
Interested in today is the um piece at the bottom so the T4 to T3 um production um getting it into the bloodstream and getting it into the th sensitive cell to influence the genetic material in the nucleus of that cell so the instruction comes from the hypothalamus you’ve got thyrotropin releasing hormone hitting
The pituitary telling it to um produce TSH and you can see that there’s negative feedback so when the T4 and T3 are at the right level the TSH um levels should be lower now I just want to say a word about TSH because there’s often conversation about
Whether T3 has an influence on TSH or is T is a high T4 in the bloodstream enough to reduce your TSH and to be honest yes it is so the inactive T4 can give you a normal TSH result and you will still be feeling awful because you’re not
Activating to T3 the more powerful hormone so the thyroid gland um it produces the three hormones T4 um some T3 uh around 80% um is T4 maybe 20% T3 and then it produces calcitonin and calcitonin is really interesting because we do have some research about its impact in the
Kidneys with vitamin D production it may also facilitate the entry of calcium into the bones but we don’t have very good evidence on that so so it’s kind of the Forgotten hormone of the thyroid but it’s still quite an interesting one particularly as a lot of people with
Thyroid disease have some issue with their production or utilization of vitamin D and that’s back to those Snips that Dr camran was talking about so I want to talk a little bit about nutrition now so this um this slide I love this slide this is um what’s happening in your thyroid as we
Speak we hope so um if we look on the right hand side you can see the iodine coming in through a a transporter across um through the um thyroid cell and then it’s been going it’s going oh excuse me it’s going into the thyroid um follicle
Over here on the pink section um to produce the thyroid hormone you can see as we go across tyrosine is um the protein part of the thyroid hormone and production of that is dependent on selenium um we need ATP which is our energy currency to move um all of these various constituent parts
Around that’s highly dependent on magnesium and actually we find in hyper hyperthyroid so Graves disease that magnesium is often low because there’s probably increased urinary excretion and actually the thyroid um hypothyroid people may also be low in magnesium then we’ve got the Dio enzymes which have been mentioned around the
Conversion of T4 to T3 they are Seline and zinc dependent and as we move across into the pink section on your left hand side you’ve got um TPO which is the enzyme which um facilitates the production of the thyroid hormone that’s iron dependent and interestingly TPO determines how much iron we can store
And use um and if we aren’t if our TPO isn’t working very effectively that’s going to have an impact on the amount of iron we absorb and use but we need enough IR IR to make sure it’s working effectively so you can get stuck in a bit of a cycle
With that and the other issue is if there’s inflammation your body May shut down absorption of iron from the gut in a separate reaction so you often find iron issues in thyroid dysfunction but again iron needs to be tested before it’s supplemented because it um is toxic
At higher levels so then we’ve got selenium there supporting a glutathione enzyme for the iodination of tyrosine so selenium is protective and it’s also functional in the production of the hormone so you can see why it’s so important it is very easy to get to a toxic level of selenium the recommended
Um upper limit is 200 micrograms but you can see toxicity at those levels so probably a safer level is around 50 micrograms and then if you see at the bottom the center bottom of the screen you’ve got zinc which is and supporting superoxide dismutase which is a protective enzyme in the production of
The thyroid hor hormone and the reason why we um Dr kumran mentioned iodine being an issue what can happen is these TPO enzyme operates in sort of a hydrogen peroxide bath and if you bring a lot of iodine in it overstimulates the thyroid gland and you can just imagine
It’s working much harder and there’s sort of a bubbling of this hydrogen peroxide and it splashes around and it damages the um thyroid cell and the damaged thyroid cell signals the immune system that that it needs to be clear and if that’s happening at quite a high
Rate you have an increased risk of autoimmunity developing and obviously that could be your trigger but you do need the genetic susceptibility around autoimmunity as well so um so I really want to talk about what you can do to improve things so if we’re thinking about producing the
Hormone in the first place so this is basically producing T4 so your thyroid gland a functional healthy thyroid gland can produce 100 micrograms of T4 per day so if you find your medication is going above that dose um there’s something going on with conversion there’s something going probably going on with
Cellular uptake so the answer isn’t necessarily to just give more and more hormone um because that’s not the issue it’s not that you haven’t got enough te for it’s that your body isn’t using it properly so key nutrients in Balance it’s interesting talking about specific nutrients and their role but you know
The whole diet is what’s important but these are the these are the areas that have been studied so we talked about iron iodine zinc and selenium we’ve also got vitamin C which is an important antioxidant vitamin d and vitamin E and B complex as well are really important
B12 deficiency is relatively common in thyroid dysfunction protein levels often people aren’t eating enough protein at all and that has an impact potentially on the tyrosine but more importantly on blood sugar regulation which has a big impact on how our thyroid works but more of that later so if we’re thinking about
Things that inhibit the production of thyroid hormone stress stress is a big one and it’s very easy for me to sit here and say oh lifestyle management stress response but do you remember when we looked at the hypothalamus pituitary link so the signal is going to the brain
Around the stress response and the body thinks well if it’s a very stressful situation I probably need to conserve some energy and not produce as much thyroid hormone because I need to dial things down and also you’re going to be in increasing your adrenaline your neur adrenaline your cortisol and that may
Also inhibit your thyroid function so stress is a big one and for some people particularly with autoimmunity stress can be a real driver of the condition so they’ll notice if they’re under deadline um if they are um having trouble at home so for example I often see people when
They’re just coming off some very stressful situation I had one client who developed psychosis um which turned out to be thyroid anti B is not um bipolar um and that was following um lots of deadlines at work and a bullying atmosphere at work or post divorce or post um childbirth anything that can
Increase stress um can have an impact on thyroid and like I said it’s just such a fussy little gland autoimmunity which we’ve talked a little bit about today so whether that’s Graves or Hashimoto um pesticides heavy metals the gland is really sensitive to those selenium and zinc um are in a similar in
The same group in the periodic table as mercury and then you’ve got fluoride in the same group as iodine so they can kind of jump into the thyroid gland and take the space of the nutrient minerals so the thyroid gland is quite sensitive to those nutrient deficiencies um we’ve
Covered the nutrients that are important so if you haven’t got enough of them you’re not going to be making enough hormone if you have uncontrolled inflammation oxidative stress that puts a big demand on the body and potentially your thyroid won’t function as well under those conditions you’ll see more and more information
About um uncontrolled inflammation unhealthy levels of inflammation and that does have a big impact on your thyroid hormones eating too much eating too little and food sensitivity so Dr Kuman talked about the gluten issue um Dairy also can be a problem for some people um but the whole I mean I think
It’s really important to work out what specific Foods you’re sensitive to rather than removing them and making your diet you know missing out on certain nutrients so conversion to T3 is just so so so important for us to feel well so we know it’s around four times more
Active than T4 we do produce some like I said maybe about 15 to 20% is made um in the thyroid but the majority is around conversion of T4 so we have deiodination which is one iodine molecule being removed and that’s facilitated by among others dio2 it takes place mainly in the liver
But also in the muscle kidney and brain now if it’s taking place in the liver muscle kidney and brain it’s important particularly around liver function that that’s optimized muscle is often quite hard to build in um thyroid conditions so how do you manage your diet um to build enough muscle for this effective
Conversion to take place because you need T3 in the first place to build muscle so you can see how you get into Vicious Cycles with the thyroid um kidney and brain again if it’s if you have a lot of psychological symptoms with your thyro um underfunctioning or overfunctioning thyroid so for example
Depression mood Mania and we’ve really got to think about what’s happening in the brain and if that conversion from T4 to T3 is taking place and this is really important as we get older around cognitive function and memory so things that increase the conversion so the key nutrients in balance that we
Would think about vitamins a e and zinc it’s important to think around toxicity um levels and safe upper limits so vitamin A can quite quickly come in at a higher level than you would like it’s fat it’s fat soluble and we store it so it’s not like you pee it out if you’ve
Had too much it gets whacked into the liver and maybe you can well you can technically overdose on it it’s quite rare but it does happen and vitamin E is also fat soluble so you need to be careful around the dosages but interestingly hardly any of our food has
Vitamin e in it anymore and when I run vitamin and mineral tests on people vitamin E is often the one that comes out low because you would expect to be getting vitamin E in um for example olive oil or other plant oils um and what happens is at the harvesting site
They are siphoning off the vitamin E to put into capsules so if you test for example olive oil most of the olive oils on the market in the UK don’t have any vitamin e in them because it’s been sold to the supplement industry um so you
Know to get the vitamin E You’ need the need to eat the whole seed so the sunflower seed you could eat the olives um but if you’re looking at plant oils as a source of vitamin most of them don’t have it an anti-inflammatory diet okay so that is such a broad sweeping
General term um I’m going to talk a little bit about at the end about General guidelines um the diet you know this is a lifelong condition you may put it into remission which is wonderful but it is still not cured um so you do need
To be careful for the rest of your life about how you eat so the diet that you adopt needs to be sustainable it needs to um allow you to have a social life it needs to um give you enough energy and not be so restrictive as you’re terrified of all
Foods um that’s my that’s my opinion now working in nutrition for a long time the more restrictive the diet is the harder it is to stick to the more likely people are to bounce off it and the more lonely they’re likely to become because um they can’t hang out with their friends
Anymore because they’re eating this really restrictive diet and well balanced blood sugar so it might seem really basic but when your blood sugar goes too high or too low um if that has an impact on your thyroid it’s through insulin signaling uh is one mechanism another mechanism when it goes too high
Your blood becomes a little bit sticky and we produce these proteins and advanced glycation end products is where basically the sugar sticks to Something in the blood and creates a product that shouldn’t be there which makes it less functional and they then trigger the immune system which will then have an
Impact on thyroid hormones and when the inflammation is high you can’t convert well from T4 to T3 so hooray you’ve made enough T4 but there’s so much inflammation going on on the b in the body that it can’t convert to T3 so we have um the dio2 snip I’m going to talk
About Snips in a minute over and under nutrition this is really around the hypoglycemia hyperglycemia and again uncontrolled inflammation oxidative stress and the high and low blood sugar so the next stage of this tricky process is to get the thyroid hormone onto the cell wall through the cell and
Into the nucleus to influence the DNA within that nucleus to produce certain proteins uh functional proteins for the ity so how do we make sure we’re getting the thyroid hormone where it actually needs to go we’ve made it we’ve converted it it’s in the bloodstream you
Do the test the test looks normal but you still feel awful what is happening to that thyroid hormone within the cell so if we want to increase the sensitivity of the cell to the thyroid hormone stabilize your blood sugar number one adequate vitamin A adequate zinc and the right type of exercise
So what do I mean by the right type of exercise it needs to um not stress you out so if you’re doing cardiovascular exercise no longer than 20 to 30 minutes but the type of exercise that seems most helpful in thyroid conditions is resistance training building up your
Muscle um because there’s so many so many reasons I I’m not going to have time to go into them all but one of the big things that the muscle does is it converts to T3 and the other is it acts as a SN for excess sugar in the blood
Which is is so beneficial and also um resistance training done correctly doesn’t um drain you doesn’t make you exhausted and the good news is some of it you can do seed which is quite nice so you don’t have to do hours and hours of cardiovascular exercise in fact I
Would say that’s one of the biggest mistakes I see with my clients is the type of exercise that they choose to do is cardiovascular um I had one woman woman who is running on a treadmill for two hours a day and couldn’t understand why she put on three stone so um the
Right type of exercise and things like um yoga Pilates are very beneficial as well things that reduce the cellular sensitivity so you’ve got less chance of getting the T3 into to exert its effect nutrient deficiency uncontrolled inflammation and blood sugar highs and lows so all of those are controllable through your diet
So there’s so many different points where you can intervene in this Cascade to improve how you feel so I’m going to talk a little bit about gene expression epigenetics um epigenetics is really interesting so it’s basically how your genes Express themselves so you have approximately six foot of genetic material in each cell
How does the body decide which bit of that genetic material to use if you can imagine there’s little buttons on top of the genetic material and um certain behaviors and nutrients switch them on and certain behaviors and nutrients switch them off so what you’re trying to do is you’re trying to choose the
Behaviors and nutrients that switch on the good genes essentially and that’s your epigenetics and then the combination of your genotype along with your epigenetics that’s called your phenotype that’s the expression of your genes and that determines health or lack of health so you can see here on the
Left hand side you’ve got all these different factors feeding into your epigenetic so your nutrition your lifestyle factors that was sort of the stress idea loneliness is a big problem as well around um epigenetics toxicant so um pollution um Plastics um you know um exhaust from
Cars all of that can have a big impact on how our EP our genes Express themselves pathogens so they’re disease causing agents um Epstein bar virus so if you’ve had glandular fever um helicobactor poori um the microbiome massive source of um Gene switching on Switching off so
That’s to do with your mainly what’s been studied is your gut microbiome and mainly what’s been studied within that is bacteria but there’s also all the viruses that live in your gut that maybe we don’t know so much about and then there’s all the the fungal growth that
Lives in the bacteria lives in the gut as well and all of those can send signaling messages to hit the right or the wrong button okay so I’m going to talk about Snips now so Dr kran has mentioned these These are alterations in the genetic code that results in a change in the
Proteins being produced and when you’re doing reading about it you’ll come across some terms so the wild type that’s the common form of a DNA code and that’s on both of the chromosomes you get one chromosome from your um mother one chromosome from your father um heterozygous you’ve got different alals on each
Chromosome and homozygous two identical variant alals on each chromosome so which is the good one okay so wild type is the good one that’s the one that’s most functional heterozygous less functional and homozygous less functional still so the way I like to think about it wild type
Was like you were on a Motorway with hardly any cars and you’re just powering down and you’ve got loads of room to maneuver there’s lots of space for reactions to take place so heterozygous you’re more like you’ve hit the a road so you can still move but maybe you
Can’t go as quickly as you would like and then per person C with the homozygous that is more like um you’re on some windy Country Road it’s really hard to get around and if you get any more traffic on that road you’re going nowhere so even if you’re on the
Motorway you can still have an awful lot of traffic that’s causing an issue and the traffic in this instance would be like lot background inflammation nutrient deficiency Etc so that’s some basic terminology and a real sort of lay Person’s Guide to what wild heterozygous homozygous but I do find that road analogy really
Helpful and the other thing to say about Snips and we were talking about why aren’t they available on the NHS the research on um Snips changes a lot so even this di io2 which was first really talked about in 2009 we still don’t have like Reams and reams of evidence to say
That this is necessary important Etc we don’t have the amount you know with them the NHS with nice guidelines they want definitive evidence before they r a recommendation and that can be really frustrating for people um awaiting treatment and for people working within the NHS system so one of the problems
With a lot of this stuff is it’s preclinical so this is preclinical information and you know the some of the Snips that Dr Kuman was talking about are actually in the preclinical stage so but the problem is you’re sitting in clinic with somebody with a massive
Problem and you want to do what you can to help them so if you’re practicing safely then you will use the current available evidence and adapt the protocol for the person based on the results that come back but in you know and there is um a sort of a rule of
Thumb around research breakthroughs taking 20 years to hit the um GP practice which is no good for you now you know do nobody here wants to wait for 20 years to feel better okay so the results can be one of three combinations you remember I mentioned the wild the
Heterozygous and the homozygous and the results will come back saying either um T um for treine c for cytosine I haven’t written it on so you’ve got the wild type TT heterozygous TC and homozygous CC so if you remember what I said about the the motorway the motorway is TT
While type yes please I want that one heterozygous TC or I’m on the a road could be better but it’s not Dreadful homozygous CCO oh okay probably need a bit more intervention here I’m on that Country Lane and I’m not going very fast so you can see here um what’s happening
Um where it’s happening so the um T4 on the sorry I can’t tell my left my right so it takes me a while to work out which side of the slide I want to tell you to look at T4 is dropping through the cytoplasm those blue lines on the top on
The right hand side um and dio2 is conver is facilitating a reaction to T3 and that’s happening within the cell and you can see here the green bar at the bottom is um around the nucleus and the transcription of the message so the T3 goes to the nucleus attaches to it
And tells it make this protein please this is what we require and if you have T4 you can see T4 doesn’t attach to the nucleus so it’s like swanning around not doing much the other thing is if you’re taking more and more T4 medication you begin to degrade
Your dio2 enzyme so it doesn’t really help to take more and more T4 medication because there’s less dio2 around to make the active hormone okay so this is what the result later would look like so TT wild type no genetic predisposition for decreased T3 synthesis heterozygous decreased ability
Of the enzyme to generate the active T3 hormone again you’re on the a road and homozygous you’re on the Country Lane you’ve got decreased ability of the enzyme to generate the active T3 hormone and the additional information that’s given here is this genetic variation is associated with an increased risk of
Obes obesity and I want you to look at that word Associated ass Associated doesn’t mean causal it means that they’ve looked at a group of people with this um snip and they’ve looked at their weights but they so there is an association but there’s no direct link proven which is potentially why you
Don’t get it moved up the um you don’t have your um di2 measured on the NHS um so the CC and the CT so the CC is the um Country Lane and the CT is the a road they’re going to have reduced ability to convert at T4 to T3 in the
Brain skeletal muscle and brand adapost tissue so if you’re not converting it in the brain do remember I said that’s going to have an impact on how you feel so really quite low mood um depression deeper than other people without hypothyroid um disease is more is going
To be more common so if you’re suffering a lot with very low mood then I would consider this being an issue um getting the um because you’re going to be relying then on the bloodstream which doesn’t cross the bloodb brain barrier so you’re not going to have enough of the T3 to
Feel good and to have good memory so we do have with um underperforming thyroid we do have an increased risk of cognitive decline um which really nobody wants so you changing medication to a combination of T4 to T3 May improve psychological well-being and about 16% of people with hypothyroid have this snip
So that’s you know of the total population of the hyperthyroid people for every 16 have the snip so um when Lynn asked us to look at this presentation I went through the data that we have at regeneris and I looked at the last 200 results to see
What um we had found so wild type we’re on the motorway 39% of people who feel like their T4 medication is not working don’t have a problem with converting it according to this test TC hocus so we’re on an a road there is a there is a a
Slowness it isn’t as efficient as you would like 40% but the CC the homozygous um The Country Lane going nowhere 21% so we’ve got 61% of results indicating potential gen genetic issue with the conversion of T4 to T3 so the results they come with a letter to share with your GP and some
People have used this to ask for a T3 medication prescription to be referred to the endocrinologist to achieve that it doesn’t it it just gives you it gives you more um more ammunition but it doesn’t necessarily get you what you need so what about the other 39% of
People who tested who F who were on increasing doses of T4 and still having symptoms so this is back to the idea of the gene expression and what we can do around um nutrition lifestyle factors and improving health so these are some general recommendations in hyperthyroid and hashimotos uh I would suggest having
High quality protein two to three times per day um if you’re feeling rubbish I would probably start with three times per day so the equivalent of a chicken breast three times per day but you can have vegetarian protein um some people think oh I’m having a really high protein breakfast I
Have eggs so if I wanted you to have 30 grams of protein at breakfast and you said oh well I have two eggs each egg has about six grams of protein so you’re only getting 12 grams of protein so that would be in if we’re looking at supporting the thyroid that would be
Quite a low protein breakfast so you need to look at the other foods that you could have to improve that so maybe a higher protein bread um maybe a protein smoothie anyway so just to say that eggs aren’t high in protein um but you can combine them with other foods and you’re
Not going to be sitting around eating steak three times a day you can make it up from vegetarian protein as well I also recommend gradually increasing um your vegetables um and choosing from colorful H brightly colored vegetables sulfurous so that’s onions and um garlic Etc I’ll show you I
Have a little picture at the end which makes it clearer cruciferous vegetables so sometimes with um thyroid patients the advice is to avoid the goitrogenic vegetables so that’s the cruciferous ones but that as long as they’re steamed it really doesn’t matter if someone was having
Lots of kale um juices that would be a problem and what theogenic vegetables do is they prevent the uptake of iodine so you don’t get enough iodine into the thyroid gland you know too much iodine is a problem too little iodine is a problem so steam your cruciferous vegetables and
You’ll be brown um control starchy carbohydrates not not not not absolutely not please please never never have low carbohydrate diet if you have thyroid symptoms because what will happen if you’re on a low thy um a low carb diet and you have issues with your thyroid with your hormone production is that um
You’re going to be relying on fat for energy when you’re on low carbohydrate and to break down the fat so it can get into the mitochondria to produce energy you need T3 you need really good levels of T3 to achieve that this is also why fasting isn’t great in hypothyroid as
Well but um what happens if you don’t have enough T3 you use um adrenaline you you use your stress hormones so you might feel tired and wired on low carb so don’t do that um finding the right amount of carbohydrates for you um is yeah it’s really important and having
The right type of starchy carbohydrates so thinking about things like sweet potatoes um plantain yam white potatoes um if you’re not if if they if they suit you um and starchy vegetables beetroot um squash all of those things are really important alongside gluten-free grains being gluten-free is usually helpful um
In studies it’s been shown to reduce TSH if you are autoimmune itely take out gluten if you are hypothyroid but not autoimmune gluten is really quite hard to digest and thyroid lack of thyroid hormone compromises your digestive system so being gluten-free is probably a bit helpful in that scenario as well
So correct nutrient deficiency the test your GP can do if you push is um B12 folic acid vitamin D and iron if your iron is low you can assume your zinc is low we don’t really have a very good test for zinc um in that we don’t know what the storage
Protein for zinc is so that’s why you know we can test the serum levels of zinc but it’s not telling you how much your body is storing but as a rule of thumb if iron is low zinc is probably low as well oh and also if you’re a vegetarian make sure you’re having
Double the recommended daily amount of iron and zinc um consider additional food sensitivities but don’t cut out loads of foods um because you’re just going to be miserable um but you can do that in a controlled way so um what should your plate look like probably
Um around a quarter of the plate is protein um so other um leafy greens and salads um other Val other vegetables so cooked vegetables um root vegetables and whole grains so that’s generally what your plate should look like and the aim if it’s autoimmune or if you’re feeling rubbish
Is to try to get as much in the way of vegetables into your body as possible so the different colored pigments represent different benefits whether they be anti-inflammatory um anti- um carcinogenic the other thing that’s really interesting about all the various pigments is that they provide an energy source the different pigments provide
Energy source for the mitochondria to produce ATP so if you think about B12 been really important in the mitochondria it’s the blue from the Cobalt in it the cobalamin the other thing that the different colored fruit and veget do is provide food for good bacteria in your gut and your microbiome
Has a massive influence on um the expression of the um the genes in your cells um so what time are we now okay so you can order the di2 test from regeneris and um if you want any more information on nutrition you can email me there um that website link takes you
To um you can sign up for um breakfasts that are helpful in hypothyroidism and there’s more information on how I work so I’m very much apologized for the technical issues at the beginning and I shall stop the share thank you very much Virginia that was really interesting
Again um hope I didn’t go to in sorry about that that’s okay um we don’t have time for for questions um but I don’t know if you’re going to hang around till the end because um I know I’ve only given like 10 15 minutes for questions at the end
But um Louise and I happy to stay on a bit longer if um people want to ask questions then and um if there’s any I can’t answer I’ll forward but if if you have the time to stay on until the end Virginia then that would be good but if
You don’t I’ll get people I’ll find out the questions from people and send them to you okay I think I can pop I can pop back in at half two okay brilliant would that work for you yeah be great yeah yeah because I’d love to chat with you guys okay thank you
Thank you it’s actually a great pleasure for me to be here and and have the opportunity to share some of our research with you um I’m doing this work with Alexandro zelis we are both economists at the University of aerin business school so I will say at the
Start that none of us have got any medical training um but but we are aware um of the the high prevalence of Ty disease amongst the general population and we have an interest on labor markets and so we started to wonder whether it wouldn’t be possible to identify some
Broad General patterns across the population on the influence of thyroid disease not only on the well-being of the individuals but also um more broadly you know on society in particular with a focus on the on the labor market Channel if you like so we started to look at the
Literature and we found that um although there is evidence that chronic diseases um affect various labor market outcomes I’m talking about diabetes clinical depression um and they and they do so by reducing employment prospects increasing absenteeism reducing productivity and lower wages and and this evidence also suggest that women seem to be more
Affected by these conditions than men uh there is very little evidence that um um on the effects of thyroid disease on labor market out outcome so we decided to embark on this on this project and and U do some work ourselves um the key stylized fact about thyroid dysfunctions
Are what informed our research questions to start with so um as we have had an opportunity already to hear today um th dysfunctions are very common we know that also very very much more common in women than men um hypothyroidism is the most prevalent condition and it affects
Women potentially 10 times more than men um subclinical hypothyroidism is the most commonly sorry is very commonly detected as well and from what you understand from the medical literature it is typically not treated or even though it can give symptoms to to those affected um there is also um a frequent
Incidence some of undiagnosed thyroid disorders and then um the the the medical literature suggest that many people on normal TSH level as we have had the opportunity to hear today also um continue to exhibit symptoms and um and and uh also the the symptoms as well as the diagnosis seems to be more
Problematic when it comes to women so the symptoms management and the diagnosis so on the basis of these stylized facts we did a a first piece of work in a which is appearing in in a paper published in economics and human biology the paper is already on line
With the journal uh where we asked whether thyroid disease and particularly hypothyroidism could contribute to explain gender differences in the labor market and uh and then subsequently whether diagnosis and then the treatment of the disease could have a positive impact on on these negative effects uh
We used a large sample of people uh 240,000 observation that we got from the UK household longitudinal survey this is a survey which basically follows people over time so we followed people over a period of 10 years uh and we concentrated on people of a working age
Uh so 18 to 65 and the data enabled us to distinguish between hyper and hypothyroidism so it wasn’t a very fine characterization from a medical point of view of the disease but we had this key distinction and then um the the there was information about without the diagnosis so we could compare
Individuals before they were diagnosed um after diagnosis uh and also we compare these people to those people who never were diagnosed over the period we thought that the results were quite interesting um I should say that this is a typical approach that we follow as Economist so we try to identify broad
Patterns in a large population as opposed to build our analysis on individual case studies and the advantage of this is you know we manage to obtain key stylized facts which may be quite relevant actually from also from a policy point of view so what we found in this paper is that thyroid
Disease in particular undetected hypothyroidism can have serious consequences for female workers um and um what these female workers experience is an increase in the gender pay Gap uh we have a base gender pay Gap in society which is around 30% that’s the difference in wages between men and
Women and this pay Gap goes up by 5% so to about 18% for those women who uh have an undiagnosed thyroid condition HP hypothyroidism um the channel that we identify um in the paper is a productivity Chanel so um the thyroid related symptoms presumably uh affect the productivity of these women and uh
And this results in a lower wage um after that agnosis this additional wage gap of 5% um is recovered gradually over time and also the employment prospects of these individuals improves so the key point that emerges from the paper is that thyroid disease can have consequences not only for the individual
Well-being of of the people concerned but also more broadly to society I mean a lot a loss in productivity uh is is an issue and and clearly this suggested the early diagnosis is an important factor now on the basis of this piece of work we decided to um to go deeper into the
Analysis and uh can you hear me hello hi yes we can hear you yeah no sorry because I I I received very I received strange messages and that’s fine and okay so um so we decided to to continue on this line of research and uh
Um one of the the strands that we have identified was implemented this year with a people’s experience with thyroid disease survey which was conducted in March um we contacted people through the thyroid Charities such as yours and we are very grateful for their help um we managed to get something like 1,200
Responses um and um around 95% of these were women so the purpose of this uh survey essentially was to try to get get a a broad picture about the well-being and labor market implications of the disease but with a particular focus on the journey from uh the development of
Symptoms to diagnosis to treatment in essence in an attempt to try to understand what factors might affect the the the negative impact of thyroid disease on well-being and labor market um I should say that uh during and after the survey we received many emails from people uh some were actually
Arguing that the survey didn’t allow them to express the complexity of their experience and this is definitely true it was so by construction I mean as I said you try to identify broad stylized facts U but uh um the you know the the the the kind of evidence that we obtain
From the emails resonates very much with what was said by thyroid patients today and and it is pretty much in line with some of the results which come out of the servies so both in the report and in the presentation today um you will see some of these statements scattered
Around um which which reflect the experience of the people concerned the um in terms of of thyroid conditions uh the sample um was uh can be described by by by this graph by this graph essentially we had 69% of people with an underactive thyroid the majority of these were autoimmune in nature uh
24% there was also 14% of sub subclinical hypothyroidism um 24% had an overactive thyroid the bulk of these were Graves and there was also 6% of thyroid cancer so um moving on to uh an analysis of the results in terms of the journey from symptoms to diagnosis and treatment the
Key points which emerge from the sery is that it takes considerable time for a thyroid condition to be diagnosed uh thyroid treatment may not be effective and the diagnosis of hypothyroidism tends to take longer than that of hyperthyroidism and people with hypothyroidism have lower levels of satisfaction with the treatment so let’s
See a little bit of evidence um about these key points uh first of all the diagnosis uh was done in the majority of cases by AGP 68% and 26% uh of cases were diagnosed by a consultant um in terms of the the lag with which the diagnosis occur um
Relative to the onset of symptoms we see that the average lag is of 4.5 years and the lck for hypothyroidism is twice as long twice twice as big as that for hyperthyroidism and between the onset of symptoms and diagnosis symptoms get worse so the L is not without consequences for the well-being of
People and treatment however follows relatively quickly um after the diagnosis is made so the average is about four months from diagnosis and this is a statement from a patient who who had to wait about 10 years for a cancer thyroid cancer to be diagnosed um now the satisfaction with
The timing of diagnosis and the timing of treatment um is not very high clearly with the given the the length takes for diagnosis to take place um it’s not surprising to find that quite a large number of people weren’t at all satisfied with the timing of diagnosis
About a third were not at all satisfied with the timing of diagnosis the the timing the satisfaction with the timing of treatment is somewhat better given that it occurs quite fast quite quickly after diagnosis uh but you will see that from the graph that there is quite a
Large percentage of people who are not very happy about uh the timing of diagnosis treatment and even with the treatment itself um again we find the difference between hypo and hyperthyroidism with Hyper hypothyroidism patients being less satisfied on all counts they’re less satisfied with the timing of diagnosis
Treatment and and and with the treatment itself um an important uh Dimension which comes out out of the servy is that the treatment may not be effective so um it takes about a year up to a year for the majority of people to start feeling the effect of treatment but there is a
Not insignificant percentage of people who have yet to feel the TR the effect of treatment now it’s important to uh stress here that because we can cross the the answer to the different questions uh that this not yet so the people who have yet to feel the effect
Of treatment are not do not consist of people who have started to to receive treatment very recently okay so you know the treatment may not be effective despite a considerable amount of time having occurred uh from from the beginning of the treatment and again hypothyroidism patients um are seem to
Be much less effectively treated than hyper thyroidism patients um now therefore we have a situation where there is a delay in the uh diagnosis there is a treatment which doesn’t appear to be uh particularly or always effective so the implication of this is that um this the the thyroid disease
Symptoms persist after treatment and although people’s wellbeing and labor market engagement and Prospects improve after treatment the Improvement is moderate especially uh when it comes to the labor market um so the the the nature of the symptoms uh both comes out very clearly from the survey is that thyroid disease generate
A a combination of symptoms which overlap and so people feel um experience many many symptoms um and what is striking is that after treatment as you can see from the height of uh the two different colors histograms um the the percentage of people uh which continue to experience these symptoms doesn’t
Fall very much doesn’t fall by very much so for example you take tiredness and slowness which is the the the symptom which is perceived by the great majority of people it falls from about 85 to 79% um after treatment and it is striking that what the survey throws uh
As an important result is that over 90% 92% to be precise of people still experience multiple symptoms despite the treatment we asked people what was the most severe symptoms and again here you see that the most severe symptoms again is tiredness and slowness and after treatment actually there are more people
Experiencing in than before so um the the Persistence of symptoms clearly has implications for the wellbeing of people and and uh it has implication also for their labor market engagement um when it comes to well-being we see that there is a considerable drop uh in the number of
People who are very much affected by the thyroid condition so it goes from 55 to about 32% but uh um I I think it is quite striking that despite the treatment we still have 32% of people who are very much affected by their by their thyroid condition um and and and this clearly
Has implications for the for the daily life of people as a lot of the statements we receive we received suggest uh when it comes to work the situation is uh is not very different again uh there is a a falling the percentage of people who are very much
Affected by the symptoms uh when it comes to work uh but about 25% of them continue to feel that their condition is affecting them very much um so work like daily life and work are uh are difficult uh with this condition uh there is some improvement of course
With the treatment people experience a you know better physical activity better personal and family life um but uh uh but the symptoms continue to affect them and when it comes to work um then uh when it comes to work the situation is actually worse because um in on a number of
Um dimensions of of of work engagement starting from employment prospects Career Development skill developments we see that um there is only about 10% of people who reported an improvement after the start of of treatment for about 60% there is basically no change at all and for 30% of people despite the treatment
Uh these uh labor market indicators actually get wors um so the Improvement in the labor market in terms of pay increase working hours and so on is all is all very limited um we asked trying we we we set up the questionnaire in trying also to understand what conditions could help
People in in overcome some of the difficulties so we asked a question about U the relationship with their employer 78% of those employed at diagnosis informed their employer uh but in 23% of these cases the employer did not appear to be sympathetic at all now
This is this is a very important a very important Dimension because in the statistical more you know more in- depth statistical analysis that we are doing um on the data from the questionnaire from the survey uh it is clear that uh those people who find that their employer is sympathetic sympathetic
Towards the condition experience a lower impact of the disease um on their ability to engage with work so I mean this suggest we come later to the policy application this suggest that it is important uh perhaps to put in place HR policies uh to support patients excuse
Me um but clearly the ability to to engage with work may have you know very strong implications for for uh the the work Pro Prospects and and also the ability to retain work by for many people um another aspect which we thought was important in in trying to
Understand or in determining the extent to which the thyroid condition can affect uh the well-being and labor market engagement with people is the relationship with the doctors so the patient doctor relationship we know from other areas that the patient doctor relationship is key and uh uh what the
What the survey suggest here is that patients do not feel uh on average that they are hearded Enough by the healthcare professional and this is something that even you know the the the few statements that we hear today um from patients um um is consistent with that people however F felt more involved
And empowered when diagnosis was made by a female consultant and hypothyroidism patients felt less involved empowered and patient patients with hypo with hyperthyroidism um and other types of tyroid conditions um so this is the the the graph on the question heard by more than a third of people felt that they
Had not been heard at all by the medical profession and as you can see this percentage is higher when it comes to GPS than uh Consultants so as we we move from one to five from the noted to to very much the Consultants uh always uh um scores a bit better
Um and uh and this this sense also you know this this aspect of not being AED comes out very clearly also from the feedback uh that we received from patients um hand in hand with not being here there is the sense of involvement and empowerment of patients and here
Again uh there’s a very high percentage of people who do not feel um at all that you know they are empowered or or involved in the management of their of their condition uh they don’t feel capable of having an input and uh and uh um the situation even uh along with
Respect to this Dimension is better with the female Consultants female consultant Consultants um score a bit better on average uh consultants in general but amongst the Consultants female Consultants are better than male Consultants um so more involvement and empowerment where the when the diagnosis is made by a female
Consultant um now an interesting point again is that when we break down the sample with respect to the type of thyroid disease we see that hypothyroidism patients feel less involved and they feel uh less empowered than hyper thyroidism uh patients and this I suppose is consistent with their having a later
Diagnosis and and and and having also experiencing also greater or or or a slower response to the treatment uh than hyperthyroidism patients so what can we conclude from this um initial analysis of the Ser of the of the questionnaire of the survey um it’s an initial analysis because as
We speak we are doing more in-depth statistical analysis uh but uh what we conclude from this is that diagnosis is neither the beginning nor the end of the journey for thyroid patients it is not the beginning because uh it often occurs very late with respect to the onset of
Symptoms and it is not the end because despite the diagnosis and the start of treatment s symptoms persist there’s a considerable time for a thyroid condition to be diagnosed in particular for hypothyroidism thyroid treatment may not be effective with symptoms per existing after the start of treatment thyroid disease has lasting adverse
Effects on people’s wellbeing and labor market engagement and there is an improvement after the start of treatment but they are relatively moderate on both counts particularly when it comes to labor market uh patients on average do not feel they’re being H by the medical profession and they do not feel
Empowered during their medical Journey now this is particularly true for people suffering from hypothyroidism and uh however SA faction is higher when diagnosis is made by a female consultant now one of the aims that we had in in carrying out the survey was obviously to get you know a
Broad picture across a large sample of of of people and we think there is value in that because um if you know if you concentrate on a particular case study it is always possible that for example a a medical person may say well you know you’re you’re a special case
Uh whereas if if you identify kind of stylized facts which cut across which are supported by a large population then clearly uh it is much more easy to say that there is a problem uh with a particular situation and and we think as a result of these results and as a
Result of the results of our previous paper that thyroid conditions pose a problem on many counts the diagnosis phase the treatment and and then as as it comes out here the relationship with with the medic that’s an important aspect because in the particular you know in the specific um statistical
Analysis that we’re carrying out at the moment um what emerges for example is that if there is a higher sense of empowerment and involvement um by the patients then uh typically those people who who feel a higher empowerment and a higher involvement also have higher satisfaction with the treatment so the
Treatment is likely to be more effective uh there is a shorter period before the effect of the treatment uh are felt and uh and then we find that there are positive implications for well-being and labor market outcome so this from a policy point of view suggest it is very
Important to look into the patient doctor uh relationships um so on the basis of of this uh um of this analysis so far uh we think that uh it is possible to start thinking a little bit about what can be done and we have identified a few uh policy
Implications um on which we hope that the results of the survey will draw attention to um so the the first clearly is that you know there has to be greater awareness and we hope that this study can raise this awareness can contribute to raise this Awareness on the well-being and labor market implication
Of thyroid dysfunctions there are implications which go beyond the well-being of the individuals here so uh thyroid disease poses real cost not only to the individuals but also to society more broadly uh for example through the labor market Channel um this these results also suggest and confirm what we
Found in our previous paper that early diagnosis is of essence now clearly as has been argued earlier at the beginning by Lan in fact I mean it is important to understand why diagnosis uh doesn’t take place more readily um there uh and here again I I move to the to the point that
I mentioned a moment ago about the relationship between patients and doctors I mean clearly if patients are not being HED or uh there is a tendency to uh maybe dismiss or misinterpret their their symptoms because we know that thyroid symptoms mimic the symptoms of other conditions
Um I think I mean some some work could be done in in in that respect U there has to be a review of the effectiveness of treatment we talked we heard a lot today about the conversion between T4 and T3 we are not medical doctors here
Um but one of the the points that emerged for example from the uh the messages that we received from from patients uh we got a sense that uh and incidentally even though the questions didn’t theoretically allow that people wrote in the questionnaire they wrote they added comments to their answers and
One thing which which I think comes out is that a lot of patients have a sense of they’re being often an approach which is a one- siiz fit approach to their condition and in fact I was reading recently some some medical papers on on thyroid disease um where the the authors
Were advocating um a more uh patient centered approach but again a patient centered approach requires as as a lay woman in the sense that I’m not a medical doctor but I think it requires a better relationship with the with the medical practitioners because if if if patients cannot be
Heard in the first place then it’s very difficult uh I think to arrive at a situation where a patient centered approach is uh U Can Be can be obtained um thyroid disease is also a women’s health issue I mean it’s not not not um not solely I mean it affects men as well
But certainly it affects predominantly women and therefore I think it should be part of the the Women’s Health Awareness agenda so thyroid could well be a component uh of that agend and we were actually very surprised in reading the Women’s Health Plan strategy for Scotland and England one is called plan
One the other is called strategy none of them mention thyroid so thyroid is not there at all and and and I think an important step would be to achieve the inclusion uh of of thyroid conditions into those plans uh as a means to you know to increase awareness uh about
About the implications of the disease um I mentioned earlier the the the need to to work with the employers to develop workplace and HR policies on organization approach to St to staff experiencing thyroid related symptoms and we think that a good step in in the right direction would be the
Establishment of a UK wide thyroid task force the same as what has been done for example with respect to the menopause and and we think here of of of a task force which brings together the NHS the Medics the employers the the Patients Group the the the thyroid support groups
Um because you know it’s a multifaceted issue here that we are facing and and I think these results suggested there is an issue but but it is a complex issue and um and only you know something in a sense you know which takes a kind of holistic approach uh to it um
May be effective I’ll stop here and and I’m happy to answer any questions if I can thank you thank you very much ktia very interesting um and can I just say that um thyroid UK did include um a submission to the Women’s Health strategy and it just wasn’t
Included for some reason they didn’t include thyroid disease and we were very disappointed in that um workplace information is something that is on our list to do so hopefully we’ll get that done quite soon because I know it is important um some of uh your your talk I’m not surprised about the
Dissatisfaction but it’s very interesting to see how it affects the workplace I know myself I had to give up a job because I I just simply couldn’t do it I was in too much pain and I had to have a job where I could decide when
I worked and how I worked and I’m sure that’s happened to a lot of people and once I was diagnosed then I worked more than full time now so um it it is it’s caus it causes Havoc particularly for women and something needs to be done so
We don’t have a lot of time for questions um but nobody’s got their hand up at the moment so nobody oh someone now there yep okay so uh Saria sorry if I’ve pronounced that wrong no abolutely fine it’s sah hi hi sorry I’m a bit late joining today um
Trying to join in between my work and calendar which is quite hectic um but I’ve captured some of that presentation um which was really good in terms of what bits I’ve picked up what I wanted to ask you elves as uh leading experts as uh those that have joined this forum
Space as well is is that what is the links between the menopause perimenopause and no predisposed thyroid condition but the onset of it during that period And The Links between estrogen and progesterone because when you attend your GP appointments and you say look I’m feeling really unw
Something’s not right I don’t know what it is and I can’t get my hands on it d d da and you pause the question am a perimenopausal quite often the look at you like are you absurd really at your your age no you’re not so it’s those
Myths and stereotypes that come around a woman when a woman can be very menopausal for example and it’s got to be a certain particular age because I for certain believe I was misdiagnosed because I was in the perimenopausal stage by the age of I would say 46
47 and I was told no it’s nonsense it’s something else that’s underlining that’s going on everything was checked and this is some I was going back and forth from the doctor uh doctor for a whole year yeah and then eventually they checked my thyroid readings which isn’t done as a
Given you have to ask for that and it should be done routinely considering there’s one in 20 within the UK that could have a thyroid condition for example so I was per menopausal at the time saw your thyroid region are slightly out so from that they put me on Lev
Thyroxin only at 25 milligrams initially to start off with but once I went on Lev thyroxin treatment for hyperthyroid and this is what they were saying is that um you’re on it for life etc etc as we know I felt really really unwell worse than
Before I went to the doctor uh and ever since haven’t really felt well but I was per menopausal I’m in the full-blown menop menopause now as well and I think the links between thyroid and menopause because it’s all linked to our hormones needs to be looked at very closely and
Instead of treating the me the thyroid straight away your readings out that high that you know they they’re quite within the four five six ranges um and they go straight for treating your your Lev thyrox instead of addressing the estrogen progesterone levels that might be out of sink in your body that’s what
My question is and this is something that we need to look at very closely in terms of research in terms of having those difficult conversations that we have to have with our GPS that don’t understand uh the correct management of thyroid conditions or menopause or per menopause
Stages I know that’s a bit of a long- winded thing that I’m asking I hope you can capture the essence of what I’m trying to draw out I’m not sure if Kya can answer that question no no I’m not I’m not qualified to answer the question I can I could only describe the
Experience of my mother but it’s not it’s not relevant here yeah I mean in in my experience um definitely the the symptoms can be very similar between thyroid disease and the menopause I don’t think that GPS Test properly for perimenopause or the menopause privately you can get quite good testing done to
Tell exactly whereabouts you are um and we know that estrogen can affect the thyroid negatively um when you’re taking the pill and things like that um and I’m I think probably that the the levels that change when you’re in per menopause or menopause will affect the thyroid as
Well and not enough research has been done we definitely need more research on that but thyroid itself isn’t an area where people want to do research very often you know it’s the big the big issues heart cancer children all kinds of things like that but thyroid comes
Right down on the list of research and this is something that we want to do we want to do something where we get everybody together it’s called the James Lind Alliance priority setting partnership where we get together patients advocates ADV ad advocacy people doctors researchers we all get
Together to decide on the 10 most important questions that we want answered um and that could include menopause and thyroid and and and what happens unfortunately to do that it will cost about 25 to 30,000 um it is on our list of projects to do when we get some more money coming
In and we do now have a fundraiser so I’m hoping it’s not going to be in the twoo distant future that we can do that but I’m not sure that ordinary researchers are very interested in that area having said that menopause has come right up in
The media now yeah um so it may be that somebody wants to do how thyroid affects the menopause and vice versa um hopefully quite soon but it is difficult so everyone as previously mentioned I am Rachel Hill from the invisible hyperism athid patient advocacy blog and website
Which I set up in 2015 now so I’ve been around for a little while um I’m here today to talk about the benefits of raising children the grandchildren children in our lives um to know the signs and symptoms of a third condition um and why we can all benefit from doing
That next slide so first of all a bit more about me I am a multi-award-winning thyroid Patient Advocate speaker content creator on social media and an author of as of today three books I have been involved in the th advocacy world since 2015 when I was diagnosed with autoimmune
Hypothyroidism so that was Hashimoto alongside hypothyroidism um as many of us have those um those two things in combination going on um I had had many many years of unexplained symptoms of fatigue muscle aches and pains um really heavy periods Camp cramping in my calves hair loss as
All of us can relate and the symptoms can just be really Relentless and endless and that was me too until I eventually got that diagnosis I share real experiences of having autoimmune hyperthyroidism and I work hard to improve awareness of the signs and symptoms and to encourage more
Of to get that full testing and explore full treatment options as well as consider other lifestyle um kind of interventions and changes that can help us with our health as well so that can include things like exercise diet changes um and just how we kind of live
Day-to-day to try and optimize our th Health as best as we can um with all of this this is where kind of making more children from a young age aware of the symptoms can tie in as well so next slide please so how many of us knew the signs
And symptoms of a thid condition before we were diagnosed raise your hand if you didn’t yeah I’m sure that’s a lot of us a lot of us didn’t even know where a thyroid gland was um had even heard of the word th before we got diagnosed and that’s really not uncommon although we
Really do face struggles with feeling as if medical professionals are taken a Ser lot seriously a lot of the time when we keep going in complaining of these mounting symptoms um how much quicker could we have been diagnosed if we had had a bit of an inking that it could be a thyroid
Condition and we could have asked for those tests ourselves I know that I didn’t have a clue I’d spent years feeling increasingly fatigued frustrated achy having all those mounting symptoms that I was talking about and I did not have a clue that they were connected to
This one health condition and if I had been made aware of the signs and symptoms of hypothyroidism and hashimotos from a young age not least because it may have run in my family then I could have asked for and received that thyroid test and that thyroid diagnosis sooner and thus I
Could have had an earlier diagnosis saving years of lost and missed opportunities but by the time I was diagnosed I felt like I’d lost years of my life and I was I was at the point where my my health was so bad that my quality of life was quite hugely
Affected and by the time I was diagnosed my health was in a terrible place it had got into such a bad condition that I wasn’t able to work I was bedbound and I often said that I felt like a 91y old living in a 21 year old’s body so yes I
Had developed a thid condition when I was really quite young but as such not one doctor thought to check my thyroid function for many years despite me complaining of symptoms throughout childhood but they were really mounting up when I got to those teenag years next slide please
So the very Act of advocating for earlier diagnosis and treatment of thid issues means that we need to be increasing awareness among young people by being open with the young people in our lives whether they are our children our grandchildren family friends we are giving them the advantage of being able
To spot the signs in themselves or possibly even their loved ones future spouse friends sooner imagine if we could save them the years that many of us lost trying to get diagnosed ourselves or their future partner or a future friend who just so happens to have an undiagnosed thyroid issue or
Their own children one day thyroid issues can skip generations and many people who receive a diagnosis are shocked to learn that other people in their family have a thyroid issue too because it’s just not spoken about often enough even within friend and family circles next slide please so we can help future Generations
By being open about the thyroid symptoms we experience personally because as we all know they can differ somewhat from person to person we can also share what helps us with the children in our lives we can also share what flares look like for us what helps us and how flare days
Might Impact Family Life we can also talk about what full thyroid testing looks like and how just going by TSH alone leaves a lot of us undiagnosed or under treated basically I think that we need to make it less of an unknown it doesn’t need to be a scary and worrying
Taboo subject it can be something that we have an open dialogue with the children in our lives about next slide please now through saying all of this I do want to make something clear and this is something that’s taken from my book that was published today the respons the
Responsibility of managing our theid condition does not of course lie with our children but we can benefit from working as a team to understand what it looks like how we can live well with it and how to get through those trickier days and I say this because I feel that
We work best as a family when we work as a team a mutual understanding and opening communication can really really help here next slide having two children who ask me a lot of questions like what are those pulls you take and Mommy why are you so
Tired some days and why can’t you eat gluten like the rest of us um I decided that they couldn’t be the only children with questions around my thyroid condition there must be other children who are wondering these sorts of things too whether they verbalize them or not
And we of course want to seize this opportunity to educate them so that they not only understand their grown-up situation but also so that they can be aware of the signs of a thyroid condition in themselves or the people around them too I know that by having
Two sons My Two children are male the chances of me passing my thid issue down to them is much less compared to if I had daughters but it’s still not a 0% chance and I don’t want them to go undiagnosed for even a second longer than they have to because like you guys
I know what it feels to lose all of those years feeling frustrated and lost so thara superhero my new book released on this world thara day answers their questions in a non-scary way it’s also encourages us to start what may feel like a tricky conversation but by opening that dialogue we’re teaching
Them to advocate for themselves early on next slide please th superhero covers a wide range of families represented throughout the illustrations what thid flares look like such as fatigue needing to rest and perhaps even having to cancel and reschedule plans as symptoms get in the way it covers the third jigsaw puzzle
What it is to what it looks like to treat and live with thyroid disease and we all know that it’s not just about taking that one pill of thyroid medication a day and then everything is fine it’s about diet exercise managing stress trying to optimize sleep as well
As we can especially with young children that’s not always easy um as well as looking at testing other things such as adrenal health and your vitamin levels as well which can often impact thyroid symptoms and mimic a lot of thid symptoms too thyroid superhero looks at how
Working as a team can benefit us all and how every Super thyroid superhero benefit every thyroid a superhero parent can benefit from having their sidekick as in their child to work as a team in this situation next slide please so as you’ve heard throughout this world thyroid Day event thyroid
Issues are often genetic and we have an increasing range of tools available to deal with this so let’s get the conversation going between adults and children and let’s open a dialogue I think that’s key to supporting one another with thyroid disease and making more people aware of this genetic think
Especially from a young age and within our communities I’ve been Rachel Hill thank you very much thank you uh let Me go back thank you very much we got there in the end didn’t we Rachel thank you um does anybody have any questions for Rachel I think we’ll be putting things out for anybody that would like to purchase your book um I think there is a question from
Somebody Louise will sort that out yeah Mary your microphone’s on hi that answer the question I was just going to ask where we can purchase the book um so it’s on Amazon if you you just search for the name thyro superhero that should come up um you can also
Follow me across social media and you’ll find that I’m sharing lots of um sort of pages and and I’m doing an Instagram live later today as well so if you want to actually see what’s in the book and decide if it would be helpful for you
And your situation then you can do those things too but yeah if you search on Amazon it will be there thank you thank you very much so we’re really grateful for that I think it’s an excellent idea I know when I was poorly I I missed many years I was ill for 15
Years before I was diagnosed um yeah the relationship with my children wasn’t as good as it could have been uh because of that so I think what you’re doing is great it’s um it can be truly devastating and I think there’s this bittersweetness of of me being
Diagnosed so young so I was 20 21 when I was diagnosed with a thyro condition and sometimes I wish that it I had have developed it and been diagnosed later so that I could have more of a normal young person’s life um but um yeah had I had I
Been diagnosed at that point maybe with sort of children who are 10 or or in their teen years um I think maybe that would have been a lot harder than me being able to get more of a grip on it before now having children in the last
Few years so yeah it’s um it’s it’s such a tricky um subject and I hear from so many other fellow thyroid patient parents um really struggling trying to navigate this the best that they can yeah it it is hard very hard so I think what you’re doing is the first step to
Raising awareness of of that demographic you know generally everything is leading towards older people but you know there are a lot of younger people too and that’s something that we want to do to try and reach younger people um and you know hopefully the move to our new
Office is going to give us a lot more time to be able to do more projects like that so thank you very much thank you very much for having me okay so Um I think it’s uh question time now if anybody’s got any questions that I might be able to answer for you um and uh if we get a lot of questions we’re willing to stay on a little bit more if anybody’s got any questions about anything really treatment diagnosis
Whatever um but if not then we’ll end the webinar now um thank you so much for coming um I did want to just pop up uh this so we hope you found it interesting um if you do have any questions send me an email to inquiries at thyroid UK
.org um and I do I do answer the questions um if it’s really busy it might take me a little while um but they do get answered much quicker than on the telephone because on the telephone I can be on for 45 minutes to people and as
You can imagine I wouldn’t get many queries answered during that time um but thank you all so much for coming uh I hope you have had a good day and that you’ve learned a lot um and I’ll see you again at the next webinar or is there another question so Maggie has a
Question um go ahead Maggie Maggie if you turn your microphone on we should be able to hear you yes I lost amongst the technology today and I lost an awful lot of this but what I have heard is very important but you said something Rachel that a lot
Of people don’t realize about thyroid and Dr Barry petfield explained this to me many years ago and he said that when we treat our thyroids we really need to treat the adrenals first and I wanted to know Rachel what you’ve got to say about the adrenal glands before you go because
I had two sytin tests and what the catin tests do not show up is if you’ve even got 86% depleted adrenals they will only show up um prospective Addison’s disease and you need to be 94 or 95% the adrenal disease is not picked up you’re seen as somebody who’s just
Neurotically looking for an answer for something but the adrenal glands are pivotal and I wondered what you had to say to that before you go I’d really appreciate that yeah um so to start obviously um have to make aware that I’m not a medical professional so I can’t
Give advice or anything like that but from the therapi um perspective um I am aware that you either end of the scale with adrenal issues you can have addinon Addison’s and Cushings Disease um and we know about this I think what what is still kind of up for discussion in a way
And is not as well recognized within definitely mainstream conventional medicine is this idea of adrenal dysfunction or there’s another term of adrenal fatigue that kind of bounces around but isn’t isn’t quite as accurate um I was a patient who at the time I was finally diagnosed um with my thyroid
Condition my adrenals were were wrecked like a lot of us um and I had a 4o saliva a cortisol test throughout the day that showed that um my cortisol was just chronically High constantly which although I was on thyroid medication I was starting on mexin like a lot others
Um it kind of explained why I was getting nowhere and I wasn’t feeling a lot better and actually I was feeling a lot worse to begin with um I then like a lot of us um embarked on trying to figure out what I could do to address that adrenal dysfunction side of things
And to bring the Coro down to normal places um and this took a lot of kind of persistence over a year or two I would say to finally get the cortisol levels back to the normal place so that I could actually reap more of the benefits of my
Thyroid medication and I feel like that was truly helping um I think when people first get diagnosed with a thyroid condition um you’re kind of given a pill a prescription and you’re sent on your waying anything else and a lot of us living this know that it often takes so
Much more than just take a pill every day it’s this th jigsa puzzle with many pieces that kind of slot in together and pieces can differ from person to person but adrenal issues is one of those which is really common among a lot of us I
Think a lot of us especially at time of diagnosis have some level of adrenal dysfunction um how far out of whack that is Will differ from person to person and you know I hear from people that struggle with really low cortisol really high cortisol but yet it’s not enough on test
To show up as Addison Addison or cushions and perhaps it is not but just like pretty much every other health condition um I think it’s really important to be aware and to continue to push for more progress in research in this area because like like so many other health
Conditions I don’t believe that adrenal adrenal dysfunctions happen just on one end of either end of the scale um I think there’s got to be some room in the Middle where like we know with thyroid issues um you don’t just fall within range and then you feel fine a lot of us
Know that we feel better at certain places within these ranges and I that’s that’s got to be the same for the health ises surely it’s very important what you’ve just said can I also just say that I have I don’t know if anybody can see this but I came across a book by
Anthony Williams I don’t know if anyone can see this called thyroid healing it’s called thyroid healing how important certain foods are for us and I started to I start this one side been diagnosed with bipolar when I went into the menopause which I I’m I’m not discrediting from Dr Michael Craig
Because I have a lot of respect for him but it’s not just that he said there’s three different components your your your endocrine system your your hormone system and the lyic system it all goes down with the menopause for some women because there’s a subgroup of women whose dopaminergic system does not cope
Without the estrogen the other thing is for those who start taking estrogen there can be problems because estrogen fights for thyroid and that’s when I hooked on two years ago that it might be my thyroid because my mother had it my sister had it but what this book tells
You which is quite important is there’s a drink if we take pure um apart from the arch chokes if we take pure celery juice every day there’s a cluster salt in it and that cluster salt builds up the adrenal glands and other cells in your body and once I started to do that
I began to feel my brain clearer than I’ve ever felt but nothing has taken away taken away this labored brain and labored fatigue that I’ve got and it’s it’s impacted in every aspect of my life but it is worth looking at and I also had with Virginia see you’ve just popped
Up in the screen we sent off to regeneris as well and you sent back a whole list of stuff that we were to look at from methylation to other stuff but nobody could understand it for me and because I’m now on pension credit I couldn’t work out Virginia what the
Regeneration was nobody could help me so I’m not any further forward but the the the the the juicing does help because you you have to look at your diet but it you definitely need to find out which aspect of the system has broken down because it’s easy to diagnose you with
Bipolar depression when you’re very very depressed but my four or five sisters have it as well and nobody’s really really listening so I don’t know other than the celery juice and and waiting I’ve I’ve also asked a doct Monica laska who used to work for um Maran glute Clinic she has
Been my Lifesaver over the last few years and she’s going to get what you’ve just mentioned Rachel an index test for me now just to see exactly where my adros are and see if we can build on it but I think when you become very depleted and you’re thyroid becomes um
When your thyroid becomes you’re not producing T3 I think you start developing hypoadrenalism and all these other things and you’re whacky and this can be misinterpreted as bipolar it’s so complex and we and it’s so I don’t think the GPS really have got the training to understand the Sensi itive complexities
That were all unique human beings that were all unique women and men were not all the same and that all these sorry all these categories that we’re given in these labels are so unhelpful because it might get you your pip like me and enable you to go out for
A few walks in the day you might receive your P but it doesn’t help you to get better because it shuts down any the other professionals from realizing actually this girl may be lacking in T3 her mother was her sisters are but I’m not seen as that in tck and in with the
Local GPS that I’m with I think it’s a highly complex thing and it’s so easy it’s so easy just to label you and I haven’t given up because I have faith family and friends and I know I’m going to get better from what I’ve heard today
And from what I’m going to do and what I’m going to further investigate with Monica and also the earlier talk speaker you had about all the complexities of the thyroid that can happen that ordinary doctors don’t get the the training in because it’s very limited it’s like the menopause they don’t know
How important various aspects are they don’t even know that when you’re given estrogen if you start AB reacting to it that there’s something wrong with your th because the thyroid is grasping for the the the the the thyroid is grasping for the thyroxine the estrogen sock sucks it up
Well done Maggie stick at it thank you thank you Maggie I I I appreciate it is very complex yes there are certain people some people with thyroid disease get better immediately yes some people takes longer and some people it takes a really long time because it is so
Complex and other things things are involved so I wish you all the best with that but I must go on now I think somebody else has a question yeah go ahead Tabitha sorry um it’s only to go off what Maggie said I totally I really sympathize because I’ve
Been going back and forth to doctors for a number of years now having depressive symptoms and I think it’s mostly frustration I think that’s what gets us upset we feel like crap at a crap you’re not getting anywhere with um you know I remember calling the doctors
And being told that my th Rod was out of whack my TSH was borderline and yet I was struggling to just function and I just started my lovely new job which I’m still in um and I just couldn’t retain information I was crying actually crying begging for help down the phone GP that
Was saying we can’t help you because your thyroid is just in well it was about B five um and she was telling me that my thyroid was normal and I said I don’t feel normal yeah so I totally understand and seeing you upset there I totally resonate with you because the amount of
Times I’ve been in teers feeling so so frustrated my heart goes out to you honestly and I think most of us can probably agree with that absolutely the trouble is there’s so many different aspects so many different aspects and GPS can prescribe when you go over the range
Because the range for TSH generally goes up to about 4.5 um nice uh I think nice have stated that you don’t need to be treated till you get to 10 which is we’ve always always disagreed with that it’s ridiculous what what’s the point in having a range if you’re not going to be
Treated when you go above the range they change the range as well they they actually Chang that range i’ I put in a s request for all of the thyroid tests that they’ve done on me because I just couldn’t believe what they were telling
Me and I it says on there to keep an eye redo the thyro test subclinical possible subclinical hypothyroidism and have they done it no no it’s me that’s had to like just keep on at them and just be a pain in the backside I’ve literally gone right on their nerves because I’ve had
Enough enough it’s so frustrating it’s unbelievable it is but they won’t test the T3 I asked them in there when they were doing the test I said will you test my T3 as well she said they won’t they test your TSH they may look at your T4
But they won’t look at your T3 unless you your TSH is of a certain level now that’s just ridiculous they don’t even look at T3 if your TSH is super high yeah they don’t and that’s why years ago I set up um being able to allow patients
To to get the test done privately and I know a lot of people think well I can’t afford it I can’t afford it why are you doing that but some people can afford it and if we can help those people while we’re campaigning to try and get it done for
Everybody this is the thing there are so many things that are just so wrong in diagnosis and treatment it really ised theer mean might have not might not be dealing with this now had they had dealt with it sooner and they still saying it’s normal and it’s not no it’s not absolutely not
Thank you very much I think um we have someone Michelle hi there hi um I just wanted to come on with a slightly positive story I’ve I’ve I’ve listened majority of the day today I can resonate with so many of you guys on here about all the the trials and
Tribulations you have went through but trying to first get a diagnosis and then get the this appropriate treatment and on a positive note I just wanted to say hello to Rachel and um you’re an absolute Angel because um thanks to you and thanks to your book oh my God talk
About going and fighting your own corner and get armed and honestly and I’ve been I’ve been off work for the last two years it’s been honestly just an absolute shambles from start to finish fin between um having a hysterctomy finding out ovarian cancer the the joy of surgical menopause then it was all
Underactive thyroids but even that was at the very start of the journey um so the biggest and amongst all that the biggest thing was trying to sort out your thyroid and then going back and arguing with doctors about yeah you’re normal you’re within range and then actually finding out for
Yourself what that means and my God the difference between or you’re within range to or you’re now optimal range I’ve went in armed with my nice guidelines to be able to say listen I’m still not right I know I’m not a doctor but that here’s here’s the the proof
Because You’ started your case saying well I think I should maybe try this and I should maybe try that and straight away the gp’s just no I’m not doing that I’m not doing that and then I’ve started quoting well nice guidelines say this and say this and here’s this book I’ve
Read and but and then and then after that straight away they’ve agreed yeah you’re totally right I think we should change our medication I think we should Endy I think we should like that so you’re wanting somebody somebody to listen so it is it’s just a we positive
Thing going um the last couple of months I’ve fought my corner I’m finally optimal range oh my God night and day I am a different human being and it’s just it’s just so nice so yeah just a we thanks and I keep keep fighting just keep doing it yeah just keep you know
Yourself you know yourself better than anybody else definitely oh I’m so I’m so glad that has helped um I think one of the best places we can start is to learn how to become armed with like the information and the vocabulary to go in and kind of
Fight our Corner if I think in in a in in my books I talk about um ways to prepare for like medical appointments and there are some very simple things we can do just to have a doctor actually listen instead of you know I’m I don’t
Want to get into like doctor bashing or anything like that because there are many wonderful doctors out there and they’re all doing their best it’s just if bit information what a difference it makes yeah they’re they’re doing the best with the information that they have and we’re trying to do the
Best with the information that we have and I’m all for trying to create um a working relationship with a medical professional and it might not be the first GP you go into it might not even be the second or third I think at my NHS
GP surgery it took me I believe I got to like the ninth GP it was one of the very last doctors that was actually there so it was a fair large large surgery um until I finally found one who would agree to test TSH to even check my
Thyroid antibodies I just wanted to know if if my if my hypothyroidism was autoimmune um and he agreed to test that full panel um and at that time I’d also self- sourced my NDT medication which so many people unfortunately had have to um to get any kind of quality of life back
Um and he was willing to sort of run those tests alongside that every couple of months um he didn’t give me grief for doing that he understood the situation I was in I understood the situation he was in and that he was quite limited he referred me to an endocrinologist the
Endocrinologist said absolutely not to any form of T3 whether that be Leo thyine or NDT um and we kind of formed this relationship with the best information that we had at the time but um and and the best resources that we could get but I think part of making
That successful can include knowing how to go in um speaking assertively with the information like you said you can either have a link or print out a copy of the nice guidelines quote them have them on your phone um I I’ve done all of those things too
And um it can just help us get that a little bit further and if you do go in with a doctor who is just not listening kind of making you feel a bit like a hypochondriac um brushing you off we’ve we’ve all had those appointments where
We come out and we just want to scream or we have a bit of a cry because we’re so frustrated um just know that you know you can go in with a fresh start with a fresh plan take someone in with you the it things drastically started to change
For me when I started to take my now husband but at the time my boyfriend in um because quite frankly they don’t listen to women they hysterical women in the same way that they will listen to a man going in complaining about symptoms um it’s a bit of an ongoing joke between
Me and my husband that he will call the doctors for something like an ear infection and he’ll be seen the same day medication the same day and he’s right as rain within a few days um I had I have issues with ear infections I had 10
Ear infections last year and it took me 11 months for me to finally get it resolved and that’s with someone who is already assertive and knows how to sort of work their way around um to get to an outcome and you know women are often sort of pushed pushed aside as having
Psychosomatic I.E mental um symptoms as opposed to actually treating a real physical cause um and if you’ve got something you can take in and it shouldn’t be the case but if you do have a male partner your dad brother a friend to take in with you little things like
That just might get you listened to a little bit better and even if they’re not you know you don’t have a male friend and you want to take a sister or a female friend or you have a female partner that you want to take in um then they can still also provide that
Alternative point of view from I know that for me in the early days when I was feeling absolutely awful and so of course I got upset in the doctor’s office quite early on because I I was Fed Up um they would listen to Adam my husband more compared to me kind of get
Getting upset quickly and and crying and saying I’ve got hair loss and I’m so tired and nothing’s working they could hear him saying she used to be able to walk like five five kilometers a day and now she can’t get to the end of the the
Street or I have to help her in and out of the shower or hearing that other perspective and something that’s quantifiable um seem to add so much more weight to the conversation and that is one very simple hack which I I appreciate not everyone has the budget
To um pay for private testing or see a private doctor get private prescriptions and things like that but there are some very simple hacks that don’t cost a thing that we can do that just might get us that bit further along um and just to
End I know I’ve sort of rambled on a little bit but to end what you’re talking about in terms of optimal levels and things like that um you we can all start with a good Baseline by getting a print out of our latest thyroid test
Results and they can’t say No in fact if they do say no you can go through um sort of a formal um procedure where there are forms involved that you can um request but they they would really have to put up a fight to deny you a copy of
Your test results because that is your medical information you can get a print out of those and you can check where you actually fall within range so the range is test result are quite wide um falling within range means you could fall anywhere within there um having levels
That are optimized often mean that you fall at least mid-range if not slightly further up within that range so basically you fall well within the range not only just in um and that can make as you said a huge different to people’s quality of life and symptoms it made a
Huge different to me um and to so many other people that are here and going in and requesting that is actually a very reasonable request you’re not actually asking for a different medication or anything that um is too woo woo and too crazy out there you’re just asking to be
Moved within the reference range that they already go by and that they are already okay with so again that is something very simple that um a lot of doctors if you go in um sort of prepared in the right way will consider that’s not a an absolutely crazy thing to ask
For um but yeah there are lots of things like this that that we can kind of learn to do and go in with a bit more confidence than just see if we get a bit closer to feeling a bit more back to of normal if if any of us can remember what
That old felt like right can I just say that we have some information about how to prepare for your visit to the GP um and I completely agree with you Rachel something I always tell people is if you possibly can take a man in with you it
Shouldn’t be like that but it it really really really helps um and as far as the test ranges for TSH anyway nice made a change in their last guidance where they’re kind of saying that if you still have S if a patient still has symptoms they can go anywhere within the range
Whereas a lot of doctors worry once they get to about 2.5 they don’t want to go any further but for some people just one point within the TSH range can make a huge difference to how they feel um so do bear that in mind as well but try and
Take the guidance take the nice Guidance with you if you’re going to have a conversation and make sure if you can have a man with you um I something I did right when I was really ill and I went in and I started crying and the first
Thing he said oh they’re there are you depressed would you like to have some anti-depressants yeah and I actually sobbing no I don’t want anti-depressants I’m just fed up because nobody knows what’s wrong with me you know I’m not being helped I’m so ill um so taking a man in like waitress says
It gives their view of things of how you were and how you are now and how things have changed because a lot of doctors reduce the levoxin and they get their symptoms back so if they’ve got a man with you or someone else if you prefer
To do that they can say well she was fine before you reduce the dosage can you please put it up again and and it does work that way so do be aware so thank you very much Rachel for that that’s really interesting and I completely agree I think we’re on the
Same page on those things yeah there’s a lot of things that it it shouldn’t have to be this way but while we’re still making progress in other ways if there are small things that can just help us in the meantime it’s worth sharing this stuff definitely
Yeah so um someone else got a question so I think that was Michelle wasn’t it I’ll take your hand down yeah Karen I’ve put it into the chat but this point about getting your um uh test results I don’t know if it’s National but through the NHS app you can access your results
And in my area we have an NHS patient portal I can see all my results going back historically at least to the point they’ve started to put them on so I get them pretty much before the do well actually I’ve got them looked at them figured out what I’ve got even before
The the doctor has and I’ve gone in and told him these are the results that’s what I’ve got sort me so um you know the NHS is actually really trying to be more overt and they really can’t refuse your records They really can’t they’re yours it’s your health so unless unless they
Think by giving you the records you might go and kill yourself or do something ridiculous and they’d have to be pretty clear about that to stop you they just can’t it’s not is illegal and and so by saying you shouldn’t even have to get to that conversation with them
Really shouldn’t um so just know your rights and if they’re going treating you like an imbecile then treat them like one and tell them that you’re the you know show shown the trump card that you know what you’re doing and You’ got the information you all know more than many
Of the doctors know just by listening to you now so true I I I I have said I’m not into taking men in because it makes us look weak and we’re not weak we’re very fact that you’ve dealt with all of these things for all of these years make
And brought up children and families and worked makes you very very strong and I’d say stronger than many men I’m sorry I feel strongly about it but I feel that unfortunately yourselves there are there are still some older ladies particularly I understand feel that the doctor is God
And they put them up on a pen and they won’t say anything I know I know that I have an 84 year old mother and a mother-in-law like that but I managed to convince them in the end and they now get cross it’s just that they don’t they
Can’t get into the surgery to have the r yeah so or even get the appointment there’s the real difficulty well that is now trying to get an appointment yeah with doct I’m just trying to encourage encourage you all really um and to feel empowered because you really are anyhow that’s my rant
Okay thank you uh Tabitha did you have something else to say or is that is your hand up from before um yeah I do have just one more thing to say I need to just do your homework basically for everybody I agree with Karen I haven’t got a guy to take
In with me but what I have done is is to do my homework um in fact I’ve disagreed with a surgeon recently he didn’t think I had a particular condition and I disagreed with him and I told him why and it’s because of that because I had done my
Homework and gave my reasons I’ve now been referred to genetics so it that goes a long way I think you know although I can understand some may need to take a gentlemen in with them um I think it’s really important that you learn your staff and go armed with what you know um
Absolutely you’re insisting on it you know because it does go a long way yeah I mean you know take some of our information in um unfortunately though when you’re first diagnosed or even for a while um you have brain fog and we know people find it very very hard to
Take in it’s a complex situation thyroid it’s not simple just take this white tablet and you’ll be well it’s not yeah that simple and people do struggle with reading the information unfortunately yeah um sometimes someone else can read it you know could be a man it could be a
Friend um yeah uh but then the friend needs to understand thyroid issues as well it’s it’s not it’s not that simple sometimes and you have to find your way of dealing with it I think that’s the issue oh yeah I completely get that because I’ve had the brain fog and I
Still get it I still have my days you know and if I’m feeling particularly rough I’ll save it for another day you know I’ll just rest yeah um I know about that I haven’t I haven’t told everybody but this week I’ve got coid at the moment so organizing this webinar and
Doing today has been a struggle I I will admit um but we got there in the end so you did it and you did it marvelously I know what a week to get coid though e oh dear well I think that’s everything guys thank you so much for coming
It’s been really good to to have a chat and and thank you so much to all my lovely speakers who’ve been amazing absolutely amazing and given us a lot more information even me I’ve learned something from this webinar so um I look forward to hopefully seeing you all at our next
One thank you have a good rest of the day thank you very much bye bye