Practitioners in particular must read this book.

An estimated 27 million Americans suffer from thyroid-related illnesses, the majority of them women. Yet thyroid-related diseases are often ill diagnosed, and there is much about thyroiditis and its treatment that bears greater clarification and study. Dr. Datis Kharrazian’s Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? presents a revolutionary breakthrough in the diagnosis and management of Hashimoto’s disease and hypothyroidism.

Using a fascinating approach, Dr. Kharrazian tackles the confusing science of thyroiditis by putting emphasis on the root cause of thyroid-related illnesses. After reviewing each of the ten chapters, I was in awe at Dr. Kharrazians’ line of reasoning and amazed at its similarity to an article I recently published, “Antibodies as predictors of autoimmune diseases and cancer,” in Expert Opinion on Medical Diagnostics, (Vol. 2, pp 593-605, 2008). The idea that environmental factors, in particular, infectious agents, may cause severe thyroid disorder has been in the literature since the 1940s. This book marks the concept’s full re-emergence. Dr. Kharrazian is to be congratulated for bringing together much of the current research and combining it with his vast clinical experience to come to a greater understanding of clinical and subclinical thyroid disorders. Using his approach of connecting the dots, Dr. Kharrazian is pioneering the future treatment of thyroid disorders.

It is generally accepted that thyroid autoantibodies thyroglobulin and thyroid peroxidase can reflect disease activity and progression, and are valuable in disease prediction and the classification of Hashimoto’s and Graves’ disease. While clinicians rely on antibody levels and elevations in thyroid-stimulating hormone, little attention is given to the factors involved in thyroid autoimmunity, as indicated by Dr. Kharrazian. Researchers and clinicians should be asking the question, why does the human body react to its own antigens, resulting in the production of potentially harmful autoantibodies? This event may be caused by environments factors, such as bacterial or viral infections, or haptenic toxic chemicals binding to human tissue, causing modification of self-antigens and the subsequent production of autoantibodies.The book begins, in simple terms, with the basics of the thyroid gland and the thyroid metabolic pathway. This gland is connected to many dots including gastrointestinal function, adrenal hormone metabolism, stomach acid production, brain chemistry and liver detoxification; therefore, its dysfunction can contribute to clinical manifestations throughout the body. Dr. Kharrazian uses case histories to illustrate the thyroid connection to suboptimal health. For him, a basic understanding of immune function is the first step in managing conditions of thyroid disorders. According to Dr. Kharrazian, the immune system must be addressed and be supported along with thyroid support, in order to successfully manage Hashimoto’s, prevent future autoimmune diseases, and enjoy a better quality of life.

Given its complexity, especially when it comes to autoimmunity, it is no wonder that the immune system is uncharted territory for many medical professionals. Dr. Kharrazian likens this intricate system of checks and balances to a crime movie that involves the mafia, good cops, bad cops and double crossers, in which a typical crime can go awry when any of the players deviates from his job. In this regard, he describes the role of TH-1 and TH-2 cytokine dominance in autoimmune diseases and how a new helper T-cell, called regulatory T-cell, can regulate TH-1 and TH-2 imbalance. Using natural medicine, Dr. Kharrazian guides the reader through the delicate T-helper balancing act.

The secrets for identifying six patterns of low thyroid function through simple blood tests are fully outlined. By understanding these functional blood chemistry panels, countless numbers of hypothyroid cases can be properly diagnosed and treated at an early stage. Dr. Kharrazian draws on his years of clinical experience for specific recommendations to help correct abnormal chemistries.

For me, the highlight of the book is the final chapter in which Dr. Kharrazian scientifically connects twenty-four dots to low thyroid function. My favorite four are:

  • Hypothalamus paraventricular effect promoted by cytokines, leading to low TSH
  • Thyroid resistance promoted by an elevation of cytokines
  • Down-regulated 5’deiodinase activity from elevated cytokines
  • Down-regulated 5’deiodinase from gastrointestinal dysbiosis and lipopolysaccharides (endotoxins) produced by gram-negative bacteria.

These four dots link the gut-brain connection to thyroid function, which has been the topic of many recent articles in scientific journals.

By reading this book, practitioners and patients alike will learn how to connect the dots from environmental factors to autoimmune thyroiditis. When these dots are given the proper attention, and are addressed efficiently, the lives of many patients can be changed for the better. Practitioners in particular must read this book. It will guide them through the aspects of thyroid disorders; how to identify their causes and how to tailor the most effective treatment protocol for each individual patient. Incorporating the lessons learned from Dr Datis Kharrazian’s “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?” into clinical practice will make a world of difference in the realm of autoimmune disorders.

– Aristo Vojdani


1. Lipopolysaccharide and a social stressor influence behavior, corticosterone and cytokine levels. Hayley et al., J. of Neuroimmunology, 197:29-36, 2008.
2. The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Maes et al., Neuroendocrinology Letters, 29:117-124, 2008.
3. Increased serum IgA and IgM against LPS of enterobacteria in chronic fatigue syndrome (CFS): indication for the involvement of gram-negative enterobacteria in the etiology of CFS and for the presence of an increased gut-intestinal permeability. Maes et al., J. of Affective Disorders, 99:237-240, 2007.
4. Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Fasano and Shea-Donohue, Nature Clinical Practice Gastroenterology and Hepatology, 2:416-422, 2005.
5. Bacterial lipopolysaccharide stimulated the thyrotropin-dependent thyroglobulin gene expression at the transcriptional level by involving the transcription factors thyroid transcription factor-1 and paired box domain transcription factor 8. Velez et al., Endocrinology, 147:3260-3275, 2006.

Why Do I Still Have Thyroid Symptoms?

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Why Isn’t My Brain Working?

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