WHAT IS PFAS or "FOREVER CHEMICALS"?

Written by: Lennard M. Goetze, Ed.D / Leslie Valle-Montoya, MD / Carol Kelujian, PhD

Introduction

Per- and polyfluoroalkyl substances (PFAS)—better known as the “forever chemicals”—represent one of the most pervasive environmental health challenges of our time. Their extraordinary stability and resistance to degradation have allowed them to accumulate in water, food, consumer goods, and even human tissue. Beyond their persistence, mounting research reveals profound implications for human health. Dr. Angela Mazza, whose clinical work has long focused on endocrine balance and the cascading impact of hormonal disruption, underscores the concern that PFAS are not simply industrial byproducts but endocrine-active agents capable of altering essential physiological systems.

 

Studies now link PFAS exposure with female reproductive dysfunction, including later onset of menarche, irregular or prolonged menstrual cycles, earlier age of menopause, and disrupted levels of sex hormones (1,2). These disruptions extend further to thyroid dysfunction, metabolic disorders, adrenal disturbances, and compromised immune responses, painting PFAS as silent yet powerful disruptors of multiple regulatory networks. Such findings emphasize the urgency of addressing PFAS not only as chemical pollutants but as contributors to the growing burden of chronic hormonal and systemic disorders across populations.

 

Widespread Use

PFAS have been applied in a wide variety of industries since the 1940s. They are commonly found in nonstick cookware, waterproof clothing, stain-resistant carpets, greaseproof food packaging, cosmetics, and firefighting foams (3). Because of their versatility, PFAS have spread into nearly every corner of modern consumer life. Industrial sites, airports, and military bases where firefighting foams were used heavily are now recognized as hotspots of environmental contamination (4).

Pathways of Exposure

Human exposure to PFAS occurs through several everyday routes:

1. Drinking water – Contamination from industrial runoff, firefighting foam, and wastewater treatment discharges is a leading source (4).

2. Food – PFAS accumulate in the tissues of fish, livestock, and crops grown in contaminated soil or irrigated with polluted water. Packaging materials treated with PFAS also contribute (3).

3.  Consumer products – Items like nonstick pans, dental floss, waterproof sprays, and cosmetics can be direct exposure sources (2).

4. Occupational settings – Firefighters, chemical plant workers, and textile manufacturers are at elevated risk due to frequent contact with PFAS-laden products (5).

    

PFAS and Metabolic Disorders: An Endocrinology Perspective

From the standpoint of endocrinology, one of the most concerning dimensions of PFAS exposure lies in its association with metabolic disorders. Research increasingly links these chemicals to conditions such as obesity, insulin resistance, type 2 diabetes, and non-alcoholic fatty liver disease (NAFLD) (6,7). These disorders, once thought to be driven largely by lifestyle factors, now appear to be influenced by environmental exposures that interfere with hormonal and metabolic pathways.

 

Endocrinologists are uniquely positioned to identify and monitor these effects. In clinical practice, blood tests are used to screen for per- and polyfluoroalkyl substances in individuals suspected of exposure or presenting with unexplained metabolic dysfunction. The gold standard method—liquid chromatography-tandem mass spectrometry (LC-MS/MS)—enables highly sensitive detection of PFAS in serum, providing valuable data that can guide both diagnosis and ongoing management (8).

 

Dr. Mazza, who has treated hundreds of patients with complex endocrine and metabolic imbalances, emphasizes the growing trend she sees in her practice:

“More and more patients are coming to me with unusual and difficult-to-explain metabolic abnormalities. When you begin to look closer, many of these cases align with what we now understand about PFAS exposure—obesity that doesn’t respond to standard interventions, unexplained fatty liver disease, and blood sugar regulation issues in otherwise low-risk individuals. It reinforces the need to view these ‘forever chemicals’ not only as environmental pollutants but as active drivers of endocrine dysfunction.”

This growing recognition from the endocrinology community underscores the need for routine PFAS testing in high-risk populations, particularly those presenting with atypical metabolic disorders. By pairing advanced detection methods with clinical vigilance, endocrinologists are playing a critical role in uncovering the hidden influence of PFAS on human health.

 

Why They Are “Forever”

The term “forever chemicals” highlights both their near indestructibility and their persistence within human bodies. Once absorbed, PFAS can accumulate in blood, liver, and other tissues, with half-lives in humans measured in years. Their presence has now been detected globally—in rainwater, soil, wildlife, and even in human breast milk (2,9). This enduring persistence underscores why PFAS represent not just an environmental issue, but a generational public health concern.

 

Conclusion

PFAS illustrate the paradox of human innovation: chemicals designed for convenience and industrial benefit have become global contaminants with long-term health risks. Their presence in water, food, consumer goods, and workplaces reflects both the complexity of modern life and the need for stricter regulation, safer alternatives, and proactive health monitoring. The endocrinology community’s growing recognition of PFAS’s metabolic, reproductive, and hormonal impacts marks an important step in shifting public health policy toward protecting future generations.

 

References

1.     Sunderland, E. M., Hu, X. C., Dassuncao, C., Tokranov, A. K., Wagner, C. C., & Allen, J. G. (2019). A review of the pathways of human exposure to PFAS and present understanding of health effects. Journal of Exposure Science & Environmental Epidemiology, 29(2), 131–147.

2.     Yale Sustainability. (2023). Yale experts explain PFAS: forever chemicals. Retrieved from https://sustainability.yale.edu/explainers/yale-experts-explain-pfas-forever-chemicals

3.     U.S. FDA. (2023). Per- and polyfluoroalkyl substances (PFAS) in food. Retrieved from https://www.fda.gov/food/environmental-contaminants-food/and-polyfluoroalkyl-substances-pfas

4.     World Health Organization. (2023). PFAS in drinking water. Retrieved from https://www.who.int/teams/environment-climate-change-and-health/water-sanitation-and-health/chemical-hazards-in-drinking-water/per-and-polyfluoroalkyl-substances

5.     EPA. (2024). Our current understanding of the human health and environmental risks of PFAS. Retrieved from https://www.epa.gov/pfas

6.     Liu, G., Dhana, K., Furtado, J. D., Rood, J., Zong, G., Liang, L., ... & Hu, F. B. (2018). Perfluoroalkyl substances and risk of type 2 diabetes: A prospective cohort study. Diabetologia, 61(5), 1319–1330.

7.     Verywell Health. (2023). PFAS exposure and fatty liver disease. Retrieved from https://www.verywellhealth.com/pfas-exposure-fatty-liver-disease-5270707

8.     U.S. CDC. (2022). National Report on Human Exposure to Environmental Chemicals: Laboratory methods for PFAS testing. Retrieved from https://www.cdc.gov/exposurereport/pfas

9.     The Guardian. (2025). Forever chemicals exposure linked to gene activity changes in firefighters. Retrieved from https://www.theguardian.com/environment/2025/aug/15/forever-chemicals-pfas-exposure-gene-activity

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PART 2 — Seeing the Unseen: Ultrasound Evidence of PFAS in the Body

By Robert L. Bard, MD, Radiologist

INTRODUCTION

We have irrefutable laboratory proof that PFAS circulate in human blood; the question I answer in clinic is where—and how—they leave their mark. My approach pairs serum PFAS quantification (LC-MS/MS) with high-resolution, Doppler, elastography, and contrast-enhanced ultrasound to visualize the organ-level footprint of exposure. Ultrasound does not “see” a PFAS molecule; it reveals the structural and microvascular consequences PFAS are linked to—evidence patients and clinicians can track over time.

SUBDERMAL & DERMAL MAPPING (18–24 MHZ)

In exposed patients, high-frequency probes often demonstrate punctate hyperechoic micro-reflectors (“white specks”) within the superficial fat and along fascial planes, typically non-shadowing and clustered around small vessels. Power Doppler may show peri-lesional hyperemia, consistent with low-grade inflammatory response. I document these as a count per field and map their distribution for follow-up.

LIVER: STEATOSIS AND STIFFNESS—QUANTIFIED

Given PFAS associations with NAFLD and metabolic disruption, the liver is a prime target for imaging. I quantify:

· Attenuation coefficient (dB/cm/MHz) as a surrogate for fat burden (higher values indicate steatosis).

· Shear-wave elastography (kPa or m/s) to assess stiffness (fibrosis/inflammation).

· Hepatic Doppler indices (portal vein velocity; hepatic artery resistive index) to capture perfusion shifts.

In patients with elevated serum PFAS, I frequently record attenuation elevations consistent with fatty change and mild stiffness increments; when combined with labs and clinical risk, these provide a numerical baseline for intervention monitoring.

THYROID & ENDOCRINE TARGETS

PFAS-linked endocrine effects often coincide with heterogeneous, hypoechoic thyroid parenchyma, micro-nodularity, and increased vascularity on color Doppler. I grade vascularity (VI%) and shear-wave values of the gland to objectify change—particularly helpful when patients report menstrual irregularities, metabolic symptoms, or autoimmune markers.

LYMPHATIC/IMMUNE READOUTS

Cervical/axillary nodes may display cortical thickening with preserved hila and subtle stiffness changes on elastography—an imaging pattern compatible with reactive immune activity. I record cortex thickness (mm) and strain/shear metrics to trend immune engagement alongside PFAS titers.

MICROVASCULAR & PERFUSION (CEUS/DOPPLER)

When indicated, contrast-enhanced ultrasound (CEUS) adds perfusion kinetics—time-to-peak, wash-in rate, area-under-curve—to flag microvascular dysfunction in liver or soft tissue beds. These quantitative curves frequently normalize as exposure is mitigated and metabolic control improves.

A PRACTICAL WORKFLOW

1.     Confirm exposure: serum PFAS panel via LC-MS/MS.

2.     Baseline multi-organ ultrasound: high-frequency skin/subcutis, thyroid, liver, targeted lymphatics.

3.     Quant sheet: attenuation, stiffness, Doppler/VI%, hyperechoic-foci count, CEUS kinetics.

4.     Re-scan at 3–6 months after exposure reduction or therapy to demonstrate directional change.

WHY THIS MATTERS

Patients deserve more than a lab number. Ultrasound supplies visual proof and actionable metrics of PFAS’ biological imprint—making risk tangible, guiding treatment, and validating recovery. In my practice, this imaging-plus-lab strategy turns an invisible toxicant into a trackable clinical target.

 

References

1.     Sunderland, E. M., et al. (2019). A review of the pathways of human exposure to PFASs and present understanding of health effects. Journal of Exposure Science & Environmental Epidemiology, 29(2), 131–147.

2.     Liu, G., et al. (2018). Perfluoroalkyl substances and risk of type 2 diabetes: A prospective cohort study. Diabetologia, 61(5), 1319–1330.

3.     Hu, X. C., et al. (2016). Detection of poly- and perfluoroalkyl substances (PFASs) in U.S. drinking water linked to industrial sites, military fire training areas, and wastewater treatment plants. Environmental Science & Technology Letters, 3(10), 344–350.

 

EXCERPT FROM THE SOURCE

Every image tells a story—but it takes a master interpreter to translate it into action. The Eye Within is more than a chronicle of Dr. Robert Bard’s work; it is a study in the art of diagnostic interpretation. In an era where technology captures more data than ever, Dr. Bard demonstrates that true clinical value comes from the trained eye and the disciplined mind that sees beyond the image. His expertise in ultrasound interpretation transforms scans into predictive tools, guiding treatment and saving lives.

This book is a testament to technical mastery, clinical leadership, and the irreplaceable human capacity to discern meaning from patterns that machines alone cannot explain. The Eye Within reminds us that interpretation is not just a skill—it is the cornerstone of precision medicine.

DETOXIFICATION AND ENDOCRINE HEALTH

 Clearing the Path for Hormonal Balance, Metabolic Vitality, and Longevity

Written by: Angela Mazza, DO | Edited by: Lennard M. Goetze, Ed.D

INTRODUCTION

The human body is equipped with remarkable self-cleansing systems—primarily the liver, kidneys, lungs, skin, and lymphatic network—that work continuously to filter waste, neutralize harmful substances, and maintain internal balance. Yet, the demands placed on these systems have grown exponentially in the modern era. We are no longer dealing solely with natural metabolic byproducts; our bodies are now confronted with an unrelenting onslaught of toxins and toxicants that challenge our resilience and disrupt our endocrine health.

Part 1 – WHY WE NEED TO DETOX

Toxins, Toxicants, and the Hidden Drivers of Chronic Disease

Toxins are harmful substances produced within the body or by microorganisms, such as metabolic waste, inflammatory byproducts, or bacterial endotoxins from gut imbalances. In contrast, toxicants are man-made or environmental chemicals—pesticides, industrial solvents, plastics, synthetic fragrances, and airborne particulates—that we inhale, ingest, and absorb daily. Together, they represent a constant, low-level threat that may go unnoticed for years but quietly erodes the foundations of health.

These harmful agents are not merely nuisances. They can alter hormonal communication, inflame tissues, damage cellular structures, and impair detox pathways themselves. In endocrine health, the stakes are especially high. Persistent exposure to certain toxicants—known as endocrine-disrupting chemicals (EDCs)—can mimic or block hormone signals, leading to imbalances that set the stage for metabolic disorders, reproductive dysfunction, autoimmune disease, and cancer.

ENVIRONMENTAL AND LIFESTYLE SOURCES OF TOXIC BURDEN

Modern living exposes us to harmful compounds from all angles:

·   Air pollution from vehicle exhaust, industrial emissions, and indoor sources such as cleaning agents and off-gassing furniture.

·   Water contaminants including heavy metals (lead, mercury, arsenic), pharmaceutical residues, and agricultural runoff.

·   Pesticides and herbicides coating produce and entering the food chain.

·   Plastics and microplastics leaching bisphenols and phthalates into our drinks and meals.

·   Personal care products with parabens, synthetic fragrances, and formaldehyde-releasing preservatives.

ILLNESS, INFLAMMATION, AND CANCER RISK

When toxins accumulate faster than the body can neutralize and eliminate them, a state of toxic overload arises. This burden drives chronic inflammation, a biological state linked to nearly every major degenerative disease. Inflammatory mediators disrupt hormonal feedback loops, interfere with insulin signaling, and impair thyroid function. Over time, prolonged immune activation from toxic stress can damage DNA, creating conditions for mutations and cancer development.

Research consistently links toxin exposure to increased risk of hormone-sensitive cancers—such as breast, prostate, and thyroid cancer—as well as metabolic syndrome, cardiovascular disease, and neurodegenerative disorders. For the endocrine system, where delicate hormonal balance dictates everything from mood to metabolism, detoxification is not an optional “wellness trend,” but a critical health intervention.

Part 2 – An Endocrinologist's Perspective on Detoxification

From an endocrinologist’s standpoint, detoxification is inseparable from hormonal health, metabolic resilience, and healthy aging. I emphasize that detox strategies are not just about “flushing out toxins” but about supporting complex biochemical pathways that influence hormone clearance, receptor sensitivity, and cellular longevity.

1. Supporting Healthy Hormone Metabolism and Clearance

The liver plays a central role in breaking down and eliminating excess hormones such as estrogen, cortisol, and thyroid hormones. These processes—Phase I and Phase II detoxification—convert fat-soluble hormones into water-soluble forms for excretion. When functioning optimally, they help prevent estrogen dominance, a condition tied to PMS, fibroids, weight gain, and increased cancer risk. Clearing out hormonal metabolites also eases stress on endocrine feedback loops, preventing cascading imbalances.

2. Reducing Endocrine-Disrupting Chemical (EDC) Load

EDCs such as persistent organic pollutants, heavy metals, microplastics, and synthetic industrial chemicals can imitate or obstruct hormonal messages. Over time, these disrupt the delicate dance between hormones and their receptors. Detox strategies—ranging from optimizing bile flow to encouraging sweating and boosting antioxidant defenses—can reduce the body’s EDC burden, improving the precision and reliability of hormonal signaling.

3. Improving Insulin Sensitivity and Metabolic Flexibility

Chronic toxin exposure fosters oxidative stress, low-grade inflammation, and mitochondrial dysfunction—three key drivers of insulin resistance. When detoxification restores micronutrient balance, reduces oxidative load, and supports mitochondrial repair, the result is better glucose control, energy production, and fat metabolism. This is crucial for preventing type 2 diabetes and metabolic syndrome.

4. Protecting Mitochondria and Slowing Cellular Aging

Every cell relies on mitochondria for energy. Toxic metabolites and free radicals damage mitochondrial DNA, hastening cellular aging. Effective detoxification minimizes these assaults, preserving energy capacity and supporting tissue regeneration—cornerstones of longevity medicine.

5. Optimizing Thyroid Function

Heavy metals like mercury and cadmium, along with halogens such as bromine and fluoride, can block iodine uptake and interfere with thyroid hormone synthesis. Detoxifying these agents may improve both the production and conversion of thyroid hormones, boosting metabolic rate, mood, and overall vitality.

6. Resolving Inflammation and Modulating Immunity

Many toxins ignite chronic inflammatory responses that destabilize hormonal systems and accelerate disease progression. Detoxification—especially when it enhances antioxidant reserves such as glutathione—promotes inflammation resolution, tissue healing, and a balanced immune response.

7. Preparing the Body for Hormone Replacement Therapy (HRT)

For patients beginning HRT, detoxification clears receptor-blocking toxins, optimizes liver and gut hormone metabolism, and restores essential cofactors. This not only improves the therapy’s effectiveness but also reduces potential side effects from metabolite buildup.

8. Engaging the Full Detox Network

While the liver is often the star of detox discussions, Dr. Mazza underscores the importance of the gut, kidneys, skin, and lymphatic system in clearing toxins. Supporting these systems through hydration, fiber-rich nutrition, sweating, and lymphatic movement ensures more complete toxin elimination and prevents recirculation.

9. Enhancing Physiological Resilience

Reducing toxic load improves the body’s adaptability to stress—be it environmental, emotional, or metabolic. With stronger mitochondrial function, balanced immune activity, and stable hormonal signaling, patients are better equipped to maintain vitality in the face of modern stressors.

Conclusion – A Two-Part Approach to Endocrine Detox

Detoxification is far more than a seasonal cleanse or dietary fad—it is a foundational pillar of preventive medicine, particularly in the realm of endocrinology. Part 1 underscores the urgency: modern living bombards us with toxins and toxicants that fuel inflammation, hormonal disruption, and cancer risk. Part 2, guided by clinical insights, reveals that strategic detoxification can restore hormonal balance, improve metabolic performance, protect mitochondrial health, and extend healthspan.

In a world where environmental and lifestyle toxic exposure is unavoidable, a proactive, scientifically grounded detox plan is not merely beneficial—it is essential for maintaining hormonal health, metabolic vitality, and long-term wellness.

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SCANNING TOXINS BENEATH THE SKIN:

Ultrasound’s Role in Detecting Environmental Burden

Following Dr. Angela Mazza’s call for addressing toxic load in protecting hormonal and metabolic health, advanced imaging now offers a new frontier—visualizing toxins where they settle in the body. While most detox discussions focus on liver, kidney, and gut function, Dr. Robert Bard, a master specialist in diagnostic ultrasound, brings attention to the skin as a major excretory and storage organ for harmful substances.

Reviewing Dr. Robert Bard's Intradermal Scanning of Toxicant Effects

Using a high-resolution 18-mHz thyroid probe adapted for skin imaging, Dr. Bard can scan the epidermis, dermis, and subcutaneous tissue in extraordinary detail. His findings reveal that environmental toxicants—such as arsenic, lead, mercury, chemotherapy residues, and industrial particulates—can lodge within skin layers, triggering inflammatory reactions, fibrosis, and eventual microcalcification.

On ultrasound, these deposits appear as tiny white specks scattered through the dermis, often in patterns distinct from normal skin texture. In the scans, healthy tissue presents as a smooth, uniform layer. In contrast, toxin-burdened skin displays irregular “bumpy” patterns with bright reflective spots—hallmarks of mineralized or particulate contamination. These findings can occur even in patients without visible rashes or lesions, revealing an invisible stage of toxic exposure.

Dr. Bard emphasizes that the skin, along with the GI tract, liver, and kidneys, is one of the body’s largest filtration systems. When toxins circulate in the blood, the skin can trap and hold them, particularly when other clearance pathways are overwhelmed. With advanced 3D volumetric imaging, clinicians can not only see these intradermal deposits but also measure their volume, offering a tangible metric of environmental exposure.

By combining endocrine insights on toxic burden with cutting-edge imaging, this approach creates an early-warning system—helping patients and clinicians take proactive detox measures before these silent invaders contribute to chronic disease.

SEEING BEYOND THE SURFACE and Thyroid Care in Thyroid Eye Disease (TED)

INTEGRATING VISION CARE

By: Lennard M. Goetze, Ed.D

Thyroid Eye Disease (TED) is one of the more complex and often misunderstood complications associated with thyroid disorders—one that reaches far beyond the surface symptoms of bulging eyes, eyelid retraction, or dryness. For Dr. Angela Mazza, a nationally recognized endocrinologist and chief clinical advisor to THYROIDSCAN.org, this condition underscores the importance of a truly multidisciplinary approach to thyroid health. Dr. Mazza’s work spans the full spectrum of thyroid disorders, from early detection of autoimmune thyroiditis to advanced imaging for structural and vascular changes. Her emphasis on integrating endocrinology with other specialties has paved the way for deeper collaborations that address the whole patient—not just the hormone levels.

This collaborative philosophy aligns perfectly with the insights of Dr. William Padula, a leading expert in NeuroVisual processing, whose work brings an often-overlooked dimension to TED care: the transformation of visual processing systems.

According to Dr. Padula, TED originates from an overactive thyroid that alters hormonal balance and overstimulates certain neurotransmitters. This, in turn, activates the third cranial nerve, elevating the eyelid and triggering hyper-focalization of the visual system. “It becomes not only uncomfortable from keeping the eyes open and managing constant strain and dryness,” he explains, “but the whole visual process changes.”

Dr. Padula describes two primary visual processing systems:

1.     The spatial platform system – the “forest view” that integrates posture, movement, and spatial orientation.

2.     The detail-focused system – the “tree view” that isolates and examines fine details.

In a healthy individual, these systems work in harmony, allowing a person to see a tree within the context of the forest. But in TED, the spatial platform becomes compromised, leaving the detail-oriented system unchecked. “Suddenly,” says Dr. Padula, “the whole forest turns into trees.” This imbalance disrupts posture, movement, and overall visual coordination.

The medical community—endocrinologists, functional medicine practitioners, integrative health specialists, and radiologists—plays a critical role in stabilizing the thyroid and managing inflammation. However, Dr. Padula stresses that optimal recovery also requires the involvement of a NeuroVisual processing specialist. By rebalancing visual processing, neuroreceptors and neurotransmitters can normalize, reinforcing the effects of medical treatment.

One of the tools he highlights is yoked prism therapy. For patients with third nerve overactivation and elevated eyelids, carefully applied base-up yoked prisms can realign posture and reduce the neurological trigger for eyelid elevation. “There’s a need for a better understanding of the visual process—not just 20/20 acuity—among endocrinologists and all medical professionals,” Dr. Padula emphasizes.

The future of TED treatment, as both Dr. Mazza and Dr. Padula suggest, lies in integrative vision-endocrine care—where imaging, hormone regulation, and NeuroVisual rehabilitation work in concert. Such collaboration ensures that patients don’t just regain biochemical balance but also recover the visual harmony essential for daily life.

By recognizing TED as more than an ocular manifestation of thyroid disease, the medical community can help patients truly see the forest again—not just the trees.

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Quick Facts on Thyroid Eye Disease (TED)

·        What it is: An autoimmune inflammatory disorder affecting the eyes, often linked to overactive thyroid (Graves’ disease) but can also occur in hypothyroidism or even in normal thyroid function.

·        Primary symptoms: Bulging eyes (proptosis), eyelid retraction, dryness, eye pain, double vision, and changes in visual processing.

·        Underlying mechanism: Overstimulation of neurotransmitters and muscles around the eyes due to thyroid hormone imbalance, impacting both eye movement and visual processing systems.

·        Two vision systems affected:

o       Spatial platform system – provides overall context (“forest view”).

o       Detail-oriented system – focuses on specifics (“tree view”).
When unbalanced, patients lose integration between the two, affecting posture, coordination, and perception.

·        Why prisms can help: Yoked prism lenses can improve posture, reduce eyelid elevation triggers, and restore visual balance when paired with medical management.

·        Best care approach: A combined effort between endocrinologists, radiologists, functional medicine practitioners, and NeuroVisual specialists.

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Restoring Vision Through Collaborative Thyroid Care

Afterthought by: Dr. Angela Mazza, DO

As an endocrinologist, I am often the first point of contact for patients experiencing the earliest signs of thyroid disease. My role begins with identifying and managing the underlying hormonal imbalance—whether it is hyperthyroidism from Graves’ disease, autoimmune thyroiditis, or another thyroid dysfunction. However, thyroid disease is not confined to the hormone panel in a lab report. It has systemic effects—impacting the cardiovascular system, metabolism, bone health, and, as we see with Thyroid Eye Disease (TED), the very way a patient interacts with the world visually.

TED develops when autoimmune activity triggers inflammation of the tissues around the eyes, including the extraocular muscles and connective tissues. This swelling can cause the hallmark symptoms—bulging eyes, eyelid retraction, double vision, and pain. From my perspective, these symptoms are not merely cosmetic concerns; they are indicators of active autoimmune disease that may require urgent intervention. Controlling thyroid hormone levels—often with antithyroid drugs, radioactive iodine, or thyroid surgery—is essential, but the hormonal treatment alone may not reverse the ocular changes once they’ve set in.

This is why collaboration with specialists like Dr. William Padula is so important. His work reveals a dimension of TED that is often invisible to conventional thyroid care—how the disease changes NeuroVisual processing. While endocrinology focuses on reducing inflammation and normalizing hormone output, NeuroVisual specialists can address how the brain and eyes adapt—or fail to adapt—to these changes.

We now understand that TED is not simply a “mechanical” pushing forward of the eyes. It is a complex interplay between autoimmune inflammation, hormonal fluctuations, and neural pathways controlling visual perception. Even after hormone levels stabilize, a patient may continue to experience eye strain, double vision, or spatial disorientation because the brain’s visual processing systems have adapted to a compromised platform. Without targeted rehabilitation, those adaptations may persist.

This integrated view—where endocrinologists and NeuroVisual specialists share responsibility for patient outcomes—should be the standard for TED care. As we advance, I see great promise in combining hormonal control, imaging technologies, and NeuroVisual rehabilitation. Together, these approaches can not only prevent disease progression but also restore function, comfort, and quality of life.

TED challenges us to look beyond the numbers on a thyroid panel and see the patient’s experience in full—because restoring thyroid health must also mean restoring the way they see their world.

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BIOMETRICS THROUGH QUANTITATIVE OPTICSCAN

By: Robert L. Bard, MD

 

INTRODUCTION

A new research study is underway at the Bard Diagnostic Imaging Center in NYC. Dr. Robert Bard and a local research team combines the latest biometric scanning advantages of transcranial DOPPLER imaging,  hemodynamic ULTRASOUND scanning (of the retinal, basilary and temporal arteries) and the integration of BIOFEEDBACK technology for a special research study. This neuro-scan review establishes (1) a cross-comparative study  between the technologies and (2) a multi-modality screening & monitoring protocol to record post-concussion and neurodegenerative disorders.

 

One of several major foci for this project is to explore the development of a diagnostic paradigm in the detection of post concussion symptoms including the growing reports of Chronic Traumatic Encephalopathy/CTE, identified from head concussions in military service and high impact sports.  Since 2018, Dr. Bard has been collaborating with neurologists and pain management specialists to assess the rampant growth of this progressive brain condition. 

 

INTRACRANIAL PRESSURE

Case studies with a presumptive degenerative neuromuscular disease or amyotrophic lateral sclerosis are now being examined through a non-invasive investigation of the eye.   We can observe increased intracranial pressure, which may reflect in changes in the optic nerve diameter.  [Fig. 1]  Scan of the eye (L) with a Doppler ultrasound probe shows the optic nerve diameter of five millimeters compared to the usually symmetric right almost eight millimeters. This suggests increased intracranial pressure or optic nerve tumor indicating a blood flow measure of the right anterior cerebral artery circulation that supplies the retina (approximately 60cm/s) blood flow. 

 

 

[Fig. 2] The left vessel shows a decreased pressure of approximately 45cm/s as shown by the decreased height of the blood flow graph at the bottom. These quantitative diagnostic technologies are non-invasive allowing close clinical follow-up treatment in diseases affecting the eye related to brain trauma or degenerative neuromuscular disorders.

 

Now that more radiologists are using Doppler blood flow to examine eye disease, including systemic diseases (including diabetes, brain tumors, heart disease, sickle cell disease, etc.) that affect the eye, we are hopeful that the ophthalmologic and neurological communities will start using this noninvasive technology as well to improve noninvasive and more rapid treatment of potential eye disorders, such as cancers of the eye, diabetes and glaucoma.  Another future use will be to correlate the effect of decreased vascular pulsation in the production of cerebrospinal fluid that is removed by the cleansing glymphatic system is postulated as a contributing factor in degenerative neuromuscular disease.   

 

BLOOD FLOW STUDY 101:  Hemodynamics is defined as the study of blood flow in relation to the status of the circulatory system and homeostatic mechanisms of autoregulation.   Through the monitoring of blood flow, diagnostic analysis provides answers to the health and physiological status of the target area scanned as well as cell-level metabolism, regulation of pH, osmotic pressure and protection from microbial and mechanical harm.   Assessing injuries, inflammation or mutative growths by assessment of blood flow allows diagnostic criteria regarding the severity of tissue disorders or tumor malignancy.

 

3D DOPPLER ULTRASOUND: A MAJOR ASSET TO RESEARCH

From simple case studies to double blind clinical trials, the many benefits of non-invasive imaging offers repeatable, visual confirmation of treatment efficacy.  Ultrasound is the most widely used diagnostic technology worldwide and, in particular, 3D Doppler histogram analysis is targeted to collect a patient's biometric data safely and efficiently, thanks to its vastly improved quantitative reporting capacity.

 

Under exploratory device tech reviews, this video shows the effects of electromagnetic pulse wave neuro-stimulation and the induction of improved microcirculation  on the body that are some noninvasive modalities that are easily monitored with an ultrasound scan using Doppler or elastography modalities. In the case of electromagnetic devices, the involuntary muscle contraction is evidence of the electrical changes in the targeted muscle developed by this technology which continues to find new evidence, supporting its ability to recover the body's healing process through cellular regeneration on a preliminary study, quantitative measurement that the regenerative timeline through the use of a neurostimulator through a simple before and after comparison shows the body's reaction to the therapeutic device.

 

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BEYOND THE SCALE: Endocrinologist’s Deep Dive into the Modern Weight Loss Battle

 By: Lennard Goetze, Ed.D /  Graciella Davi, PhD

Obesity is one of the most pressing health challenges of our time, with rates projected to affect nearly half of the U.S. population by 2030. Despite endless diet trends, a booming pharmaceutical market, and a culture obsessed with quick fixes, sustainable weight loss remains elusive for millions. According to Dr. Angela Mazza, an integrative endocrinologist specializing in hormonal health and metabolic disorders, the weight loss struggle is far more complex than calories in versus calories out—it is a multi-layered challenge rooted in hormones, inflammation, lifestyle, and a medical environment that often prioritizes shortcuts over solutions.

Obesity: The Complex, Hormone-Driven Condition

Dr. Mazza sees patients every day who have tried everything—diets, supplements, exercise regimens—yet remain stuck in cycles of weight gain and frustration. Many come to her with thyroid disorders, prediabetes, type 2 diabetes, polycystic ovary syndrome (PCOS), low testosterone, or are navigating perimenopause and menopause. Despite medical interventions to balance thyroid hormones, regulate estrogen or progesterone, or restore testosterone levels, weight loss often remains stubbornly out of reach.

“Obesity isn’t just a lifestyle issue,” Dr. Mazza explains. “It’s a metabolic condition that disrupts how the body processes energy and stores fat. Underneath it, you’ll often find insulin resistance, inflammation, and disrupted hormonal signals that make it incredibly hard for patients to shed weight, even when they’re doing everything ‘right.’” This creates a self-perpetuating cycle: excess fat tissue itself acts as an endocrine organ, releasing hormones and inflammatory compounds that worsen insulin resistance and trigger further fat storage. Over time, this contributes to other serious health conditions such as cardiovascular disease, stroke, and certain cancers.

The Boom in Weight Loss Medications

The weight loss market has exploded in recent years, driven largely by medications originally developed for diabetes management. GLP-1 receptor agonists for diabetes and its weight loss counterparts have dominated headlines. Pharmaceutical companies have expanded their offerings, creating versions that combine appetite suppression with muscle preservation, or pairing multiple hormonal pathways to enhance results.

But Dr. Mazza cautions against seeing these drugs as a miracle fix. “GLP-1 medications work by slowing gastric emptying, reducing appetite, and moderating blood sugar spikes,” she explains. “They can help patients, especially those with significant metabolic issues, but they are not a long-term solution on their own.”

Some medications, such as phentermine, are simply appetite suppressants with minimal long-term benefits and a history of side effects. Others, like newer combination therapies (bupropion and naltrexone), offer some support but don’t tackle root causes. “The pharmaceutical industry has been brilliant at rebranding existing diabetes drugs as weight loss solutions,” Dr. Mazza says, “but unless we address the underlying metabolic dysfunction, weight often returns once the drug is discontinued.”

 

Hormonal Health - The Hidden Key to Weight Management

While medications dominate public attention, the real foundation of weight loss lies in hormonal balance. Thyroid hormones regulate basal metabolism, dictating how efficiently the body burns calories. Declines in estrogen during menopause shift fat storage toward the abdomen, increasing metabolic risk. Low testosterone reduces muscle mass, making it harder to burn fat efficiently. High cortisol from chronic stress triggers fat accumulation, particularly around the midsection.

“Each of these hormones plays a role in how your body manages weight,” says Dr. Mazza. “You can’t just cut calories and expect the same results in someone with a sluggish thyroid or low testosterone as you would in someone with optimal hormone levels.” An integrative approach involves comprehensive hormonal testing, targeted therapies to correct imbalances, and ongoing monitoring to optimize metabolic function.

 

The Lifestyle Factors That Can't Be Ignored

Even with medical interventions, lifestyle habits profoundly influence weight regulation. Dr. Mazza highlights two often-overlooked pillars of weight loss: sleep and stress management.

“One single night of interrupted sleep can cause measurable insulin resistance for several days afterward,” she explains. Chronic sleep deprivation elevates cortisol, disrupts hunger hormones like ghrelin and leptin, and promotes fat storage. Similarly, unmanaged stress perpetuates emotional eating, cravings for high-sugar foods, and hormonal fluctuations that blunt fat loss.

Exercise, while essential for overall health, is not the magic bullet many believe it to be. “Studies consistently show that exercise alone rarely leads to significant weight loss,” says Dr. Mazza. “It’s crucial for preserving muscle, improving insulin sensitivity, supporting cardiovascular health, and reducing inflammation, but without dietary and hormonal interventions, weight loss results are limited.”

This is where integrative endocrinology shines—offering a multi-pronged strategy that combines medical insight with lifestyle medicine, aiming for long-term, sustainable results rather than temporary fixes.

 

The Role of Functional Testing and Advanced Tools

Traditional weight loss care often stops at calorie counting and BMI measurements. In contrast, integrative endocrinology digs deeper, looking for hidden barriers to weight loss. Dr. Mazza’s practice employs:

· Comprehensive hormone panels to assess thyroid, insulin, cortisol, sex hormones, and metabolic markers.

· Lipid profiles to gauge cardiovascular risk tied to obesity.

· Gut microbiome analysis and food sensitivity testing to identify digestive imbalances that may cause inflammation and disrupt metabolism.

· Continuous glucose monitoring (CGM) to track real-time blood sugar responses to different foods, helping patients make precise, informed dietary choices.

 “CGM can be a game-changer,” Dr. Mazza notes. “Patients see immediately how their breakfast cereal spikes blood sugar versus a protein-based meal. That awareness transforms their eating habits in a way no generic diet plan can.”

Psychological and Social Dynamics of Obesity

Weight loss isn’t just a biological challenge—it’s a psychological and social one. Many patients battle stigma, shame, and emotional eating patterns shaped by years of failed diets or societal pressure. Stress and trauma can imprint unhealthy coping mechanisms around food, perpetuating cycles of weight gain and guilt.

An integrative approach addresses this mind-body connection, pairing medical treatment with behavioral coaching, counseling, and supportive strategies to reshape habits and foster resilience. “We can’t ignore the emotional side of obesity,” says Dr. Mazza. “Healing the relationship with food and the body is just as important as balancing hormones or prescribing medication.”

 

The Cultural Environment: Why the Odds Are Stacked Against Us

Even as science advances, the modern environment sets patients up for failure. The food industry floods the market with processed, calorie-dense, nutrient-poor options. Sedentary lifestyles are the norm, with long hours at desks and minimal movement built into daily routines. High stress levels and disrupted sleep are pervasive. Meanwhile, marketing promises fast, effortless weight loss solutions that rarely deliver lasting results.

“Patients often blame themselves for not succeeding,” Dr. Mazza says. “But the truth is, our entire culture promotes weight gain and metabolic dysfunction. You can’t fight a hormonal and environmental battle with willpower alone.”

The Integrative Endocrinology Solution:

Personalized, Root-Cause Care

The future of obesity management, according to Dr. Mazza, is personalized, integrative care that goes beyond diet charts and prescriptions. It combines:

· Root cause medicine: Identifying and treating hormonal imbalances, insulin resistance, gut dysfunction, and inflammatory triggers.

· Lifestyle optimization: Prioritizing sleep, stress management, nutrient-rich whole foods, and sustainable activity.

· Targeted medical tools: Using medications judiciously as adjuncts, not crutches, in a long-term plan.

· Behavioral and emotional support: Addressing psychological barriers to change, fostering self-compassion, and building healthy habits for life.

“Weight loss should not be about chasing a number on the scale,” Dr. Mazza concludes. “It’s about restoring metabolic health, reducing disease risk, and empowering patients to feel strong and energetic again. That’s when weight management becomes sustainable—because it’s rooted in true healing, not a temporary fix.”

Final Thoughts

The battle against obesity is far more intricate than mainstream advice often suggests. Quick-fix medications and fad diets may offer short-term results, but without addressing the deeper hormonal, metabolic, emotional, and environmental factors at play, weight regain is inevitable. Integrative endocrinology offers a hopeful, science-driven alternative: a personalized, multi-layered strategy to untangle the complex web of obesity and guide patients toward lasting health—not just a smaller waistline.

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