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8 Common Causes of Thyroid Fatigue and How You Can Fix Them

Are you still fatigued even though you are taking your thyroid medication faithfully?

Why?

The fatigue found in thyroid disease can be because of many things.

Just taking your thyroid medication may not be enough to reverse these symptoms.

The many causes of thyroid fatigue include adrenal issues, autoimmune inflammation, food sensitivities, nutritional deficiencies, dietary issues, and even taking the wrong thyroid medication.

I will discuss each of these possible sources of fatigue and show you how to correct them.

Let’s get started…

Causes of Thyroid Fatigue

Multiple things can influence your energy level.

Unfortunately, there usually isn’t just one simple thing that you can do to reverse your fatigue.

It will require investigating all of the contributing factors and determining which of them may be playing a role in your particular situation.

​Most doctors don’t have the time in their busy office to dive into all of the possibilities.  Plus they may not even understand several of the causes or how to correct them.

That’s why you need to become aware of the causes so that you can take more control of your own health and get yourself on the road to recovery.

​1.  Adrenal Fatigue and Cortisol

The adrenal gland is your “stress” gland.  It produces the hormone cortisol.

Cortisol functions in the body by regulating blood sugar and metabolism, it activates the central nervous system, maintains blood pressure, and has anti-inflammatory actions.

Cortisol levels will go up during times of physical or emotional stress.  It speeds up metabolism so we are able to fight through that stressful time.

At first, people with elevated cortisol feel shaky, their heart may race, and they may have insomnia problems.

 Eventually the adrenal gland will not be able to produce enough cortisol to keep up with demand and the levels will drop and stay low.  This is called adrenal fatigue.

The thyroid and adrenal functions in the body are closely linked.

In fact, the TSH and cortisol levels tend to track together.

Even small changes in your cortisol level can cause significant symptoms, especially fatigue and brain fog.​

Your symptoms will vary depending on how long you have been under stress.

To determine if you have an adrenal issue, I recommend either salivary cortisol testing or better yet, ordering a DUTCH test.

You can also also ask for a serum am cortisol level from your doctor.  This does not tell you as much information as a urinary cortisol level tested 4 times in a day, but it can still be helpful.

​If your serum cortisol level is < 8, you most likely have an adrenal fatigue problem.

If it is >18, that also needs further investigation and treatment.

What to Do About It 

Stress management is essential for normal adrenal function.

This can include yoga, meditation, regular exercise, and scheduling time for hobbies and other things you enjoy.​

It is also important to avoid stimulants such as caffeine and even ADHD medications.

​Caffeine helps produce energy by putting pressure on your adrenal glands to produce more cortisol and increase adrenaline production.

That is not a good thing when the adrenal system is already weakened.

Therefore, try to wean off of your caffeine dependence if you have one.

Supplementation can also be extremely beneficial.​

How to Supplement with Adrenal Support

Why I Like It

May boost energy and well being

Almost ALL hypothyroid patients have adrenal problems

May help boost immune function

Most patients experience improvement in 1-2 months

How to Tell if You Need

I don’t always recommend testing for cortisol levels prior to treatment in every patient but if you do I recommend checking the following:

    • Serum Cortisol – AM cortisol should be between 14-16, anything less may be a problem (note: normal serum level doesn’t rule out adrenal fatigue)

How to Use

    • 1-2 Tablets per day if using Glandulars (preferably taken in the am and at noon)
    • If using supplements designed to lower cortisol like phosphatidylserine then use it at night

My Recommended Brand and Product

Adrenal Glandulars (for more severe cases of adrenal fatigue.

Get Adrenal Glandulars Here

Adrenal Adaptogens (for less severe cases of adrenal fatigue.

Get Adrenal Adaptogens Here

Phosphatidylserine (for cases of ELEVATED cortisol)

Get Phosphatidylserine Here

​2.  Inflammation from Autoimmunity

​Up to 90% of hypothyroidism is caused by Hashimoto’s Thyroiditis.  Up to 10% of the population has Hashimoto’s.  It is especially common in women (up to 20% of women may have it!).

Hashimoto’s is an autoimmune condition.  This means that something has caused your immune system to go rogue and attack a part of yourself (in this case, the thyroid gland).

This attack results in inflammatory cells increasing in that part of the body. 

Inflammation causes you to feel “worn down,” similar to how you feel when you are sick with a virus.

What to Do About It 

If you don’t know if you have Hashimoto’s, ask to be tested for it.​

This is a blood test that checks for 2 antibodies:​

  • TPO antibodies
  • Thyroglobulin antibodies

If either antibody level is >35, you have Hashimoto’s Thyroiditis.

You should also talk to your doctor about any other autoimmune conditions that could be present.​

It is also important to eat organic, natural food and avoid ​processed food and sugar.

Meal plans such as Whole 30, Paleo, and others are great for helping you stay on track and reducing the inflammation caused by the inflammatory food-like substances found in much of the standard American diet.

If you need more help, I would strongly recommend hiring a certified nutritionist to help you learn how to eat properly.​

This will be discussed more below under blood sugar imbalances.​

3.  Food Sensitivities

​Thyroid disease is commonly associated with food sensitivities.

The most common of these is gluten.  Gluten is a protein found in grain products, especially wheat.

It is estimated that up to 1/3 of the population has some level of gluten sensitivity.

About 90% of all food sensitivities occur from the following foods:

  • Wheat
  • Milk
  • Soy
  • Eggs
  • Peanuts
  • Tree Nuts
  • Shellfish
  • Fish

These food sensitivities cause inflammation of the digestive tract which can impair its ability to absorb nutrients.  When you are deficient in nutrients, fatigue is typically a major symptom.

What to Do About It 

The gold standard for identifying food sensitivities is the elimination diet.

​You can either remove one food at a time for 3 weeks, then reintroduce it and see if you react. This process could take 6 months or more to get through all of the foods.

Or, you can bite the bullet and remove all of the top 8 culprits together for 3 weeks, then reintroduce each one separately every few days.

If you react, keep that food out of your diet. If you don’t react, you can continue to eat it then reintroduce the next one on the list.

There are also some reference labs that have IgG food sensitivity testing available.

I believe the data supports that ALL thyroid disease patients ​should be gluten-free and probably dairy-free, even if you don’t react while eating an elimination diet.

I will discuss diet more under Blood Sugar Imbalances below.​

4.  Low Ferritin/Iron

​Ferritin is the storage form of iron.

Having optimal iron levels in the body is essential for normal energy production.  It also is required for normal thyroid hormone production.

A deficiency of iron causes fatigue and other symptoms such as hair loss, decreased exercise tolerance, frequent infections, and GI issues such as gas and bloating.

Hypothyroidism also affects the ability to properly absorb iron.  This creates a vicious cycle that results is severe fatigue.

Even when there is no evidence of anemia (low hemoglobin), supplementing with iron has been show to  improve energy and reduce fatigue.

What to Do About It 

​Ask your doctor for a complete iron study.

This will include a serum ferritin, total iron, and TIBC.

If your levels are suboptimal or if you continue to have symptoms of low iron, consider supplementing.

How to Supplement with Iron

Why I Like It

May boost energy levels

Up to 50% of Hypothyroid patients are deficient in iron

Helps promote thyroid conversion & function

Generally works within 1-2 months

How to Tell if You Need It

Check your iron studies and only supplement if your levels are sub optimal or low:

  • Ferritin – Optimal Levels = 40-50
  • Serum Iron – Middle of the reference range
  • TIBC (Total Iron Binding Capacity) – Middle of the reference range
  • Percent Saturation – 35-38%

How to Use

  • Liquid Iron:  start with 10 ml each day, do not exceed 20 ml per day (if you take more than 1 dose per day make sure to split it apart from one another and take at least 4 hours away from your thyroid medication)
  • Iron Capsules:  start with 1 capsule of iron and increase up to 3 per day as tolerated and based on your serum iron/ferritin levels (take at least 4 hours away from your thyroid medication)

    My Recommended Brand and Product

    Use liquid iron if you have intestinal issues such as gas, bloating, diarrhea, constipation or if you have previously failed capsule forms of iron:

    Get liquid iron here

    Use this capsule form if you don’t tolerate the liquid iron version above (some patients have various symptoms on liquid iron such as teeth pain or simply can’t tolerate the taste or texture of the liquid):

    Get iron capsules here

    5.  B12 Deficiency

    Thyroid disease is commonly associated with low stomach acid levels.  If you don’t have adequate stomach acid, you can’t fully digest your food and extract the nutrients from it.

    Inflammation from autoimmunity such as Hashimoto’s only makes the absorption of the nutrients worse.

    Lack of thyroid hormone causes nutrient deficiencies in certain vitamins such as B12.​

    In fact, up to 40% of hypothyroid patients have suboptimal levels of vitamin B12.

    B12 is directly involved in energy production due to its effects on mitochondria in the cells.

    A deficiency of B12 will decrease the efficiency of the mitochondrial energy production, which will result in fatigue.​

    If the deficiency is severe, it can also cause a type of anemia called pernicious anemia.

    – MTHFR​

    Up to 60% of the population has some form of this gene mutation.

    MTHFR (methyltetrahydrofolatereductase) is an enzyme that adds a methyl group to certain nutrients which allows our body to metabolize them.  When that enzyme is deficient, we cannot metabolize nutrients as efficiently​ which can result in a deficiency of that nutrient.

    The B vitamins such as B12 and folate are metabolized in this way.  Their levels can be suboptimal in a patient with an MTHFR mutation.

    It can also cause an elevation in homocysteine levels, which increases the risk for cardiovascular disease.​

    Read more about MTHFR by clicking here.

    What to Do About It 

    You should ask your doctor to be tested for the following:

    • Serum B12 – should be > 1000
    • MCV (mean corpuscular volume) – part of a Complete Blood Count – should be >92
    • Homocysteine – should be < 9
    • MTHFR – if heterozygous or homozygous for either mutation, you will need to take a methylated B vitamin supplement.

    If any of the results are abnormal, consider supplementation. 

    Supplementing with a B complex in addition to vitamin B12 shots can dramatically improve energy levels.

    Make sure to find a B complex with high levels of B6 like this one.

    You should also consider supplementing with B12 shots.

    Why not oral or sublingual?​

    ​Shots are superior to oral forms because they get directly into the tissues and bypass gastrointestinal absorption.

    Many thyroid patients have issues with constipation, SIBO, ​and other GI related issues that can impair absorption of nutrients.

    Completely bypassing the GI tract can help ensure that the B12 is absorbed as much as possible.

    B12 shots are one of the best ways of increasing energy levels in hypothyroid patients.

    Remember – It is important to make sure your B complex and your B12 shots are methylated unless you know that you don’t have the MTHFR mutation.

    How to Supplement with B12 Shots

    Why I Like It

    May boost energy and reduce fatigue

    May help increase metabolism and fat loss

    Help improve mood and increase concentration

    Generally works within 1-2 weeks

    How to Tell if You Need It

    Patients with the following symptoms should consider using B12 shots:

      • Obesity or weight gain
      • Fatigue or low energy levels
      • Lack of sleep or insomnia
      • Depression or anxiety
      • Hair loss or lack of hair growth
      • Serum B12 levels < 1000
      • Homocysteine levels > 9
      • MCV (mean corpuscular volume) > 92
      • High levels of inflammation

    How to Use

      • Take 5,000 mcg of Methylcobalamin every 7 days for at least 10 weeks
      • You will need 10 weeks worth of injections to saturate tissues and increase cellular B12 levels

    My Recommended Brand and Product

    Make sure you get methylcobalamin shots in a high enough dosage (5000 mcg) for best results.

    6.  Blood Sugar Imbalances

    The standard American diet is loaded with processed foods, sugar, and simple carbs.​

    Sugar and simple carbs provide a quick energy boost because they are rapidly absorbed and metabolized, but they are harmful in the long run.

    When you eat sugar or simple carbs, your glucose level surges.  That triggers your pancreas to release insulin which transports the glucose into the cells.

    The insulin then drives down your sugar.  Sometimes your body overcorrects and your glucose levels​ drop too low.

    This causes symptoms such as fatigue, shakiness, brain fog, and the desire to eat more sweets or carbs.

    You therefore eat more sweets or carbs, and the cycle starts all over again.

    The higher levels of insulin also results in long term weight gain and/or difficulty losing weight.

    If you find yourself feeling tired around late morning and mid afternoon, your blood sugar is probably on such a roller coaster.

    What to Do About It 

    The body can produce energy by using 2 substances for energy:  sugar or fat.

    Since most people eat way more sugar and carbs than they should, their bodies use sugar as the default energy source.

    In order to get off of the sugar/carb roller coaster, you will need to “train” your body to use fats preferencially over sugar.

    The best way to do this is to cut sugar and simple carbs completely out of your diet.

    Yes, you can do it!

    It typically takes 3-4 weeks to convert your body into a fat-burning machine.

    You might feel a little woozy and tired the first few days, but those symptoms will go away. 

    You will then notice a increase in energy and a drop in your appetite.  Plus, you will most likely drop several pounds.​

    There are several excellent diet plans on the market that can help you make this lifestyle change (I don’t like the word diet, which sounds temporary).​

    My favorite dietary programs include:

    7.  Poor Sleep Hygiene

    Low (or high) thyroid hormone may directly reduce the QUALITY of your sleep.

    It has been shown that thyroid hormone is involved in both REM and non REM sleep.

    This may explain why some patients can still have fatigue despite sleeping 10 or more hours per night.

    It doesn’t matter how long you sleep if the quality of that sleep is poor.

    If hypothyroidism is causing a reduction in your quality then you will need thyroid hormone replacement to fix this problem.

    If you aren’t sleeping well as a result of high stress, anxiety or reliance upon caffeine then you really need to step it up and focus on getting more sleep.

    Another important factor is to consider WHEN you are getting your sleep.

    People tend to have better functioning circadian rhythm’s when they sleep through the EVENING, and not through the daytime.

    ​In fact, studies show that people who work nights have an increased risk of DEATH from all causes and an increase risk of heart attacks.

    What to Do About It 

    Get at least 8 hours of sleep per night.

    Your bed should be reserved for sleep and sexual activity ONLY.  Avoid TV, reading, computer work, or playing on your smart phone while in bed.

    Try to go to bed at the same time every night and get up at the same time every morning.

    We are creatures of habit.  Our body will respond better to a consistent routine.

    Avoid any stimulants in the evening.  They will affect your sleep pattern.​

    Obstructive sleep apnea is also a common cause of sleep issues.  You should consider seeing your doctor to have it ruled out if nothing has worked to this point.​

    If sleep apnea has been ruled out and you are still not sleeping or sleeping well, it may be time to consider supplements.​

    How to Supplement to Improve Your Sleep

    Why I Like It

    May help improve energy levels

    May help to decrease levels of inflammation

    May help reduce brain fog and mental slowness

    Requires lifestyle change for best results

    How to Tell if You Need It

      • You should be getting 8 hours of quality sleep every night.
      • If you find yourself waking up exhausted then you should consider checking for sleep apnea or a trial of the following supplements to improve sleep

    How to Use

      • Take each supplement as indicated on the bottle or as recommended below
      • In addition to these supplements make sure you practice adequate sleep hygiene, that means: black out curtains for your bedroom, noise cancelling ear plugs, having a consistent sleep schedule, and avoiding all electronics 3 hours prior to your scheduled bed time

    My Recommended Brand and Product

    For minor sleep issues start with supplements containing 5-HTP which may promote proper melatonin production and induce sleep naturally (take 100mg 30 minutes before your scheduled bed time):

    Get 5-HTP Here

    For more difficult cases consider the addition of melatonin + 5-HTP, start with 1-3mg of melatonin and don’t be afraid to use melatonin if you need it.

    Get 5-HTP and Melatonin Here

    For more the most difficult cases consider using serotonin and GABA potentiators. These supplements help enhance GABA and serotonin neurotransmitters in the brain and help induce deep sleep.

    Get GABA/Serotonin Potentiators Here

    ​8.  Are You On The Right Thyroid Medication?

    It’s important to end this article by discussing your thyroid medication.

    Most physicians are trained to manage thyroid disease by monitoring the TSH level.​  “Normalizing” the TSH is typically the only treatment that is done.

    However, even when the TSH is “normal,” studies show that patients may have 20-30% less circulating T3 and T4 levels compared to age-matched controls.​

    The most sensitive marker to determine cellular levels of thyroid hormone is the reverse T3:free T3 ratio​.

    That’s why it’s important have a complete thyroid panel drawn, not just a TSH.

    By far the most common medication used by physicians when treating hypothyroidism is a T4 only medication like levothyroxine or Synthroid.

    If you’re body isn’t converting T4 to T3 like it should, then adding a T4 only medication will not be enough to increase your cellular thyroid hormone levels.​

    If your cellular thyroid levels are low, fatigue will be a predominant symptom.​

    What to Do About It 

    ​Ask your provider to order a complete thyroid panel which includes:

    ​If your reverse T3:free T3 ratio is < 0.2, ask your provider about changing to a natural dessicated thyroid (NDT) medication such as Armour Thyroid, WP Thyroid, or Nature-throid.

    These medications consist of about 20% T3 and 80% T4.

    Adding T3 only medication such as Cytomel to your levothyroxine is also an option.

    I discuss thyroid medications in much more detail in my article found here.​

    If your doctor is unwilling to do this, you may need to find a different doctor that is willing to work with you.  A doctor who specializes in functional medicine would be preferred.

    ​Summary

    Fatigue is a very common symptom of thyroid disease and may indicate a deeper problem ranging from hormone imbalances to nutrient deficiencies.

    Simply replacing thyroid hormone may not be enough to completely energize your body and reduce your fatigue.

    It is important to take a comprehensive approach to the problem and investigate all potential contributing factors.

    The combination of these therapies above has proven to be very effective in my patients and I believe they can help you as well.

    Make sure to employ ALL of the therapies that are relevant to you and your situation.

    Now it’s your turn:

    Are you suffering from thyroid fatigue?

    What have you tried?

    Leave your comments below! ​

    The Best Treatments for Hypothyroidism

    Have you been diagnosed with hypothyroidism?

    Have you been prescribed a medication?  If so, do you feel any better?

    Are you wondering if there is a better treatment than what you are taking?

    Are there any dietary changes or supplements that would help you feel better?

    I will try to answer these and other questions ​in this article.

    Here we go…

    More…

    How Does the Thyroid Work?

    In order to understand the different treatment options, it is vital to review what exactly the thyroid is and why it’s important.  I discuss this in detail in this article.

    Basically, the thyroid is vital for metabolism, growth, development, and temperature regulation in the body.

    The thyroid gland by itself cannot produce thyroid hormone.

    That activity is controlled by the pituitary gland in the brain which secretes thyroid stimulating hormone (TSH).  It measures the level of T4 and T3 which determines how much TSH to secrete.

    Once stimulated by TSH, the thyroid will then produce mostly T4, which is the inactive form of thyroid.  

    ​Primarily the liver and muscle cells then convert the T4 to T3, which is the active form of thyroid.

    The T3 molecule then enters the cells of the body and attaches to the thyroid receptors, which activates genetic transcription and tell the cells to perform the functions that it is designed to do.

    Every step of this process must work efficiently.  If any step is defective, the cell will not perform the job it was designed to do as well as it should, and the patient will develop symptoms of low thyroid (hypothyroidism).

    Factors that Affect Thyroid Function

    As I explained earlier, there are several steps required in order for the body to have normal thyroid levels.

    1. There must be adequate thyroid production by the thyroid gland.
    2. The body must be able to convert T4 to T3.
    3. T3 must be able to bind to the thyroid receptors in the cells
    4. The cells must be able to start gene transcription which causes it to perform the function it was intended to do.

    If any of these steps is defective, the patient will develop symptoms of hypothyroidism.

    Multiple things can affect each step of this process:

    Decreased Production of Thyroid Hormone

    1. Stress
    2. Infection
    3. Trauma
    4. Medications
    5. Fluoride – competes with iodine in the thyroid
    6. Toxins – Pesticides, heavy metals
    7. Autoimmune conditions
    8. Iodine deficiency
    9. Iron deficiency
    10. Zinc deficiency
    11. Selenium deficiency
    12. Vitamin deficiency – E, C, D, B vitamins

    Over Production of Reverse T3

    This is a default hormone that competes with T3 at the cellular level.  High levels reduce thyroid function and indicate what is called thyroid resistance.

    1. Stress
    2. Infections
    3. Trauma
    4. Medications
    5. Low calorie diet
    6. Inflammation – chronic diseases such as diabetes
    7. Toxins
    8. Liver/kidney dysfunction

    Decreased T4 to T3 Conversion

    1. Selenium deficiency
    2. Zinc deficiency
    3. Vitamin D deficiency

    Decreased Cellular Sensitivity to T3

    Decreased Cellular Sensitivity to T3 –

    1. Lack of exercise
    2. Vitamin A deficiency
    3. Zinc deficiency

    Treatment of Hypothyroidism

    Medication –

    1. T4 only – levothyroxine, Levoxyl®, Synthroid®, Tyrosint®

    This is the standard medication that is prescribed by the vast majority of physicians.  It is synthetic T4.

    It is generally very well tolerated with few side effects.

    If the hypothyroidism is purely due to a deficiency of thyroid hormone, these medications will be very beneficial.

    However, if there is a problem with conversion of T4 to T3, or there is a thyroid receptor issue in the cells of the body, a T4 only medication will be inadequate to raise cellular levels of thyroid to the optimal level.  This is called cellular hypothyroidism.

    A large percentage of patients have issues with this conversion.  As a result, many do not get complete symptom relief with a T4 only medication.

    If your doctor is prescribing a T4 only medication and is monitoring your thyroid level by only checking a TSH and/or T4, there is a high likelihood that you will not have as much improvement or feel as good as you could.

    2. Natural Dessicated Thyroid (NDT) – Armour Thyroid®, WP Thyroid®, NP Thyroid®, Nature-throid®

    NDT is purified porcine (pig) thyroid.It contains both T4 (about 80%) and T3 (about 20%).  It also contains small amounts of T2.

    Many patients will feel better on NDT compared to T4 only medication because it already has some T3, so it’s not completely dependent on the body’s ability to convert T4 to T3 for it to work.

    However, some patients may still need more T3 than is in NDT to get complete symptom relief.

    3. T3 only –

    T3 medications can be broken down into 2 types –

    1. Immediate release (IR) – such as Cytomel® and Liothyronine
    2. Sustained release (SR) – this is compounded Liothyronine usually bound to methylcellulose

    Immediate release T3 is rapidly absorbed in the body and peaks in the blood in about 2-3 hours.

    The majority of people tolerate the immediate release form.  However, some people are very sensitive to T3, so this may cause symptoms such as jitteriness or heart palpitations.

    Most cells in the body take weeks to respond to activation from T3.  The heart, however, is different.  T3 works directly on calcium channels in the heart which causes the heart to pump harder and faster, which can cause palpitations.

    If you have these symptoms while taking immediate release T3, they will usually resolve by switching to sustained release T3.Sustained release T3 is bound to a substance such as methylcellulose which slows the absorption of T3 in the body.  This prevents the surge of T3 in 2-3 hours that you get with immediate release T3.

    Thyroid Management Principles

    I typically recommend patients start with NDT medication.  However, if their free T3 level is in the high 3s or low 4s, it is reasonable to start with a T4 only medication.

    Insurance plans also tend to prefer T4 only medications, so they may be cheaper for the patient.

    However, if the patient does not get adequate symptom improvement and/or their free T3 level remains low, they should either be switched to NDT, or a T3 only medication should be added to their regimen.

    If the patient continues to have a high reverse T3 and a low T3 level despite being on NDT, a T3 only medication may need to also be prescribed for a short time in order to flush out the reverse T3 and reset their system.  This usually only takes a few months.

    Traditionally, thyroid medication has been taken first thing in the morning on an empty stomach.  No food or other supplements or medication should be taken for a minimum of 30 minutes to 1 hour.  However, there is now evidence that the best time to take these medications may be in the evening.

    By the way, thyroid medication should be held the morning that the patient is having their thyroid labs drawn.  Otherwise, the T3 levels in the labwork could be affected.

    After starting a patient on thyroid medication, I typically follow up with the patient in 2 months.  At that time I ask about symptom improvement and any possible side effects from the medication.

    Once you have reached maximal symptom control and the lab results are in the optimal ranges, the labs should only be checked every 6 to 12 months.

    Supplements –

    As has been previously discussed, thyroid function can be adversely affected because of nutrient deficiencies.

    Our food simply doesn’t contain the same amount of nutrients that it had even 40 years ago.  Plus, the standard American diet is woefully short of many nutritional needs.

    Therefore, it’s important to eat organic as much as you can, but you may also need to include some vital supplements to get the nutrients to the levels that our body needs.

    1.Selenium –

    • Selenium is essential for the conversion of T4 to T3.  A deficiency of it has been shown to increase your risk for thyroid disease.
    • Selenium has also been shown to reduce thyroid antibody levels in Hashimoto’s thyroiditis.
    • Recommended dose is 200 – 400 mcg daily of selenomethionine for a few months.
    • Of note, eating 2 brazil nuts contains roughly 200mcg of selenium.
    • Fish and sunflower seeds are also good sources

    2. Iodine –

    • Iodine is an essential micronutrient for normal thyroid function.
    • Iodine deficiency is common and can directly cause a suppression of thyroid hormone production.
    • Iodine supplementation by itself can actually suppress thyroid function if iron and selenium are deficient.  Therefore, it is important to add selenium if you take an iodine supplement.
    • Recommended dosages of iodine is to start at 200-300mcg per day and slowly titrate dose based off of symptoms – discontinue if you experience negative side effects and seek professional help
    • Read more about iodine here.

    3. Iron –

    • Iron has been shown to be essential for normal thyroid function.
    • Not only is iron required to produce thyroid hormone, low iron levels are also associated with  low levels of free T3.
    • Also, if you are low in iron, your body will not utilize iodine even if you are supplementing it.
    • Iron levels are assessed by checking a serum iron, TIBC and ferritin level.  Ferritin should be 40-50, while iron and TIBC should be in the middle of the reference range.
    • Recommended dosage is 10ml daily of liquid iron, or 1-3 capsules daily.

    4. Zinc –

    • Zinc is another nutrient that is essential for hormone function in the body, including the thyroid.
    • Zinc supplementation has been shown to improve thyroid function.
    • It helps with conversion of T4 to T3 and also helps with cellular sensitivity to thyroid hormone.
    • Recommended dosage is 30-60mg daily.

    Diet –

    So, what is the best diet for someone with hypothyroidism?

    That is not an easy question and there is not a quick answer.  Every person is unique.​  

    In my opinion, you can’t go wrong if you keep this simple rule – eat what God made and avoid what man made.

    That means eating organic, whole foods.  You should avoid processed foods, sugar, and most grains.

    Summary

    Hypothyroid is an extremely common condition, affecting up to 40% of adults.

    Thyroid medications include T4 only medication, natural dessicated thyroid, and T3 only medication.

    Effectiveness of the thyroid medication depends on its absorption, the ability of the body to convert T4 to T3, and the sensitivity of the body’s cells to the thyroid hormone.

    Nutrient deficiencies are common and can affect the thyroid hormone’s production and function.  

    Supplementation with the appropriate nutrients may be necessary for proper thyroid function.

    Eating an organic, whole food diet can also help maximize the thyroid function in the body.    

    Now it’s your turn…

    Have you been diagnosed with hypothyroidism?

    What medication were you prescribed?  Did it make you feel better?

    What other things have you done that have helped?

    Leave your comments below.

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    Hypothyroidism – What Are the Symptoms and How to Diagnose It

    Do you think you have a thyroid issue?

    ​If you have found this blog, I suspect you are searching for answers.  You probably haven’t felt good in years.

    You ask friends for their opinions.  They each have their ideas, but no real solutions.

    You might have read an article in a magazine, or on the internet, or maybe even on a Facebook post that discussed thyroid issues, and you thought “That is describing me exactly!”

    You probably even went to see a doctor.  You told him or her your complaints, they took a quick history, performed a simple physical exam, and then ordered some lab tests.

    You might have even left hopeful, thinking that maybe this would be the time that someone finally figured out what was going on in your body.

    Your hope was soon dashed, however, when you received a call from the doctor’s office telling you that all of your labs were “normal.”

    More…

    The doctor probably offered a prescription for an antidepressant, or a sleep aid, or a pain medication, or some other type of prescription to treat one of your symptoms.

    You might have even been prescribed a thyroid medication, but you were disappointed when you didn’t really feel any better after taking it for awhile.

    Even though you don’t know what is going on, you know that something isn’t right.

    Perhaps you have even thought that this was your new “normal” and you would just have to learn to live with how you feel.

    Unfortunately, that doctor could have been me until a few years ago.

    Countless patients have come into my office over the years complaining of things such as unexplained fatigue, weight gain, depression, hair loss, mood swings, cold intolerance, headaches, dry skin, lack of libido, etc., or any combination of the above.

    Doctors are taught in conventional training that if you want to assess the thyroid, just check a TSH level.  If it is high, the patient has hypothyroidism.  If it is low, the patient may have Grave’s Disease or Hashimoto’s Thyroiditis.  If it is normal, then the patient does not have have thyroid disease.

    Simple, little to no thinking involved.

    Unfortunately, nothing is ever that simple, especially when dealing with the human body.

    Doctors are aware of a vast array of other thyroid tests that are available, but most don’t believe they are necessary.  

    To be honest, they may not know how to interpret the results or know what to do with them even if they did order them!  I know I didn’t until I learned a better way – the correct way.

    The vast majority of patients with these symptoms will have TSH levels in the “normal” range.  Doctors often don’t know what to do with those patients, so they typically resort to prescribing medication for depression, or insomnia, or pain, or headaches, or even weight loss medication.

    In other words, the downstream symptoms are treated instead of looking upstream to find the root cause of the problems.

    Some experts estimate that up to 40% of the population has hypothyroidism.  That’s one out of every 3 people!  Yet only a small fraction of them are diagnosed and even fewer are treated adequately.

    What is the Thyroid and What does it do?

    What exactly is the purpose of this butterfly-shaped gland at the base of our neck?  What does it do?

    The answer is a lot, actually.  

    It influences almost all of the metabolic processes in the human body.  That includes metabolism, growth, development, and body temperature.

    It is essential for normal brain development in infants and children.

    The hypothalamus secrets the hormone thyroid releasing hormone (TRH) which stimilates the pituitary gland to secrete thyroid stimulating hormone (TSH). 

    TSH then stimulates the thyroid gland to produce primarily T4 (and small amounts of T3).  

    The liver and muscles metabolize T4 into T3 (active thyroid hormone).  

    In the presence of inflammation, stress, nutrient deficiency, etc., higher amounts of reverse T3 (rT3) may be produced which works to block T3 activity in the body.

    Symptoms of Hypothyroidism

    1.  Fatigue – even after sleeping all night.  You may constantly feel like you need to take a nap during the day.
    2. Weight gain or the inability to lose weight.
    3. Mood changes – anxiety, depression, or mood swings
    4. Hormone imbalances – irregular periods, PMS, infertility, low sex drive
    5. Muscle or joint pain – includes tendinitis, carpal tunnel syndrome, etc.
    6. Cold intolerance – feeling cold when other people don’t, cold hands and feet, body temperature consistently below 98.5 degrees.
    7. Dry or cracking skin, brittle nails, excessive hair loss
    8. Constipation
    9. Brain fog – poor concentration, poor memory
    10. Neck swelling, snoring or hoarse voice

    This is an extremely compact list – the actual list of possible symptoms is MUCH longer.  An extensive list can be found here.  However, if you have several of the ones listed above, the chances of you having hypothyroidism is extremely high.

    By the Way – It is important to understand that symptoms of hypothyroidism often overlap with other hormonal problems in the body.

    Adrenal fatigue, peri-menopause, and menopause (andropause in men) often present with very similar symptoms to hypothyroidism.

    It takes an experienced practitioner who can perform a thorough history, physical, and some targeted laboratory tests to distinguish what exactly is going on.

    It may even be a combination of several conditions!

    Diagnosing Hypothyroidism

    Prior to the 1970s, hypothyroidism was a purely clinical diagnosis – doctors made the diagnosis after taking a thorough history and performing a physical exam.

    After the TSH lab test was developed, it became the gold standard in diagnosing hypothyroidism.

    Many doctors have now stopped looking for symptoms or clinical signs of the disease and almost solely depend on the lab for the diagnosis.

    Unfortunately, this misses the vast majority of patients that are suffering from the condition!

    The purpose of the lab tests should only be to confirm what the provider has already found after talking to and examining the patient.

    As a wise old doctor told me when I was in medical school, “If you listen to the patient long enough, they will tell you what is wrong with them.”

    Thyroid Lab Tests

    1. Thyroid Stimulating Hormone (TSH)

    • This hormone is produced by the pituitary gland in the brain. Its function is to stimulate the thyroid to produce thyroid hormone.  Conventional medical training has taught doctors that it is an inverse measurement of the amount of thyroid hormone in the body. However, it really is only a measurement of the amount of thyroid hormone present in the pituitary gland itself. The pituitary contains a different type of deiodinase (an enzyme that converts thyroid hormone to another type of thyroid hormone) than the rest of the body, so it is really not a true indicator of cellular levels of thyroid hormone in the rest of the body.
    • Ideal range should be 0.4 – 1.0. Anything higher than 2.0 indicates a problem (usually hypothyroidism). Anything less than 0.4 (if you aren’t on thyroid medication) could indicate hyperthyroidism, such as Grave’s Disease. 

    By the way – some experts suggest that the normal range for TSH should be lowered to 0.4-2.5.  This is because when the reference ranges were established for the TSH, the highly sensitive TSH test was not available, and the reference populations included people with various degrees of thyroid disease such as Hashimoto’s.  The National Academy of Clinical Biochemistry indicates that over 95% of normal individuals have a TSH level below 2.5.

    2. free T4

    • T4 is the primary thyroid hormone made by the thyroid gland. However, it doesn’t do much if anything in the body. In order to become “active thyroid,” it must go through deiodination which removes an iodine molecule and converts it to T3. A free T4 level is an indicator of how much thyroid hormone is not bound to protein and is available in the body.
    • Ideal range should be in the upper 1/3 or so of the reference range.

    3. free T3

    • This is the measurement of how much active thyroid hormone is in your blood that isn’t bound to protein.  This may be the most important test to assess thyroid health.
    • Ideal range should be from the upper 3s to 4.4.

    4. Reverse T3

    • This is sort of a default hormone that is produced if the body is under stress, or has inflammation from chronic disease, or if there is a nutrient deficiency of some kind.
    • Levels >15 are indicative of thyroid resistance and what we call cellular hypothyroidism.

    5. Thyroid Peroxidase Antibody (TPO)

    • This is the measurement of antibodies to an enzyme that plays a part in the production of thyroid hormone.
    • Levels >35 are diagnostic of Hashimoto’s or autoimmune thyroiditis. It is important to monitor these antibody levels when you have been diagnosed with Hashimoto’s.
    • A level <35 does not necessarily rule out the presence of autoimmune thyroid disease.

    6. Thyroglobulin Antibody

    • Another antibody that is produced when you have Hashimoto’s thyroiditis.
    • Levels >35 are diagnostic of the disease.

    7. Sex Hormone Binding Globulin (SHBG)

    • This is the protein that binds to thyroid and the sex hormones in the blood. It is an indicator of thyroid function in the cells of the body. The higher the thyroid level, the higher the SHBG goes.
    • Ideal range is 70-80 in women, 20-30 in men. This level is also affected by estrogen.
    • If this level is low, treatment with T4 only thyroid medication made be inadequate.

    8. Ferritin

    • Iron must be present in normal levels in order for the thyroid to operate properly. Ferritin is the primary test used in thyroid patients.
    • Ideal ferritin range is 70-80.

    Okay, So Now What?

    If you have many of the symptoms listed above and you have lab tests that confirm your suspicions, you can officially be diagnosed with hypothyroidism.

    I discuss treatment options in my blog here.

    ​Now It’s your turn…

    Do you think you have hypothyroidism?

    Have you had problems getting a definitive diagnosis?

    Anything in this article that you learned?

    Leave your comments below.

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    Why Testosterone Is So Important

    Why is testosterone so important?

    It may be the most misunderstood of all of the hormones in the body.

    Thanks to anabolic steroids and the misuse of them, many people are afraid of testosterone and have received lots of false information about it.

    In fact, it is an essential hormone that both men AND women need to live happy, healthy, energetic lives.

    If the levels of testosterone are not optimal in your body, it will be almost impossible to have the quality of life that you should ideally have.

    If you are having fatigue, loss of muscle strength, loss of libido, night sweats, headaches, cold intolerance, and if you are gaining belly fat, you may have a testosterone problem.

    Let’s dive into this hormone further to learn more about it and address much of the misinformation that many people may have. I will also discuss symptoms, testing and treatment.

    More…

    What Is Testosterone?

    Testosterone is a hormone that is produced in the testes and to a lesser degree in the adrenal glands in men. It is produced in the ovaries and adrenal glands in women.

    Testosterone is the hormone that grows tissue in the body.

    It is responsible for muscle growth, bone growth, hair growth, sexual function, sexual drive (libido) and is essential for overall health and feelings of well-being.

    Testosterone Facts

    • Men aged 30-70 will lose 1-3% of their total testosterone every year.
    • Women will lose half of their testosterone production between ages 20 and 40.

    Consequences of Low Testosterone

    Let’s dive into these more.

    Heart Disease –

    I believe that optimizing hormones is key for prevention of disease, including heart disease

    Several studies have shown that testosterone not only doesn’t cause heart disease, it is actually protective. Here is another study.

    A study from the American Heart Association’s journal Circulation showed that as the testosterone level drops in men, their risk of heart disease increases.

    The authors even suggested that the testosterone level could potentially be used as a marker for predicting which patients were at high risk of developing heart disease.

    By the way, doctors today are taught that statin medications (Lipitor, Zocor, etc) are essential to reduce the risk of heart disease.

    In fact, if you follow some of the guidelines, the majority of adults should be on a statin.

    However, whether statins actually reduce the incidence of heart disease is controversial.

    I personally think it is more important to get the body into balance, including hormones. Most inflammation and disease will resolve without the need for medications.

    Alzheimer’s Disease –

    Studies have shown that low testosterone has been associated with worsening cognitive function in older men.

    On the flip side, it also appears that testosterone therapy improves mental function in men.

    In case you’re wondering, it also seems to help in women.

    Diabetes –

    A study published in 2013 found that low testosterone levels may help predict if a man will develop insulin resistance or type 2 diabetes in the future.

    It is unknown whether low testosterone increases the risk of diabetes, or if both conditions are due to the majority of those patients being overweight.

    Regardless, there is a definite connection between low testosterone and type 2 diabetes.

    Prostate Cancer –

    Doctors have been taught that testosterone can cause or worsen prostate cancer.

    This simply is not true.

    This belief was based on a flawed study from 1941.

    Multiple studies have since shown no increased risk – ​Here, here, here, and here are some examples.

    In one study, healthy males were given super high doses of testosterone, but they had no increase in PSA or the size of their prostate glands.

    In fact, having low levels of testosterone was shown to be a risk factor for developing prostate cancer!

    Osteoporosis –

    1 in 7 of postmenopausal women have osteoporosis.

    Half of all women over 50 can expect to suffer an osteoporosis-related fracture during their lifetime.

    After a hip or vertebral fracture, death either caused directly from the fracture or due to a secondary problem is as high as 25-35%!

    That is why we should do all we can to reduce this risk.

    Testosterone has been shown to increase bone density.

    By the way, calcium does not increase bone density significantly, but vitamin D reduced the risk of fractures by 16%.

    Breast Cancer –

    Testosterone also seems to protect against breast cancer.

    It is believed that testosterone down-regulates the estrogen receptors in the breast which inhibits breast cancer growth.

    Conditions such as PCOS where the testosterone levels are elevated are not associated with higher breast cancer rates. In fact, they may actually have lower rates.

    By the way, micronized progesterone does not increase breast cancer and may in fact be protective.

    If you are on synthetic progesterone (medroxyprogesterone, norethindrone, etc), you should talk to your doctor about switching to micronized progesterone (Prometrium or bioidentical).

    There is also evidence that iodine supplementation reduces breast cancer risk.

    Symptoms of Low Testosterone In Men

    Symptoms of Low Testosterone in Women

    If you have 5 or more of the above symptoms, you have a high likelihood of having a low testosterone level and it’s time to go get tested.

    Many of the symptoms of testosterone deficiency mirror those caused by other hormone issues, especially hypothyroidism and adrenal fatigue.

    Are you tired because you have low thyroid, low testosterone, or adrenal fatigue?

    What about your insomnia, or weight gain, or mood swings? Which one is causing it?

    The answer is possibly all of them!

    That is why you need a thorough history and comprehensive lab tests performed before your individual story becomes clear.

    Bonus information for women: If you have hot flashes during the day – 40 seconds of heat that begins in your chest then moves to your face – you most likely have low estrogen levels.

    If you have night sweats – you wake up drenched in sweat to the point that you sometimes even have to change clothes – you are most likely low in testosterone.

    Diagnosing Testosterone Deficiency

    I believe it is essential to diagnose and treat adrenal and thyroid issues before addressing the sex hormones such as testosterone.

    They should at the very least be addressed at the same time.

    If your testosterone is low but you are also dealing with adrenal and thyroid issues, you simply won’t feel better until your adrenal and thyroid issues are corrected, even if the testosterone becomes optimized.

    So, how do you know if you are low in testosterone?

    Labs for Low Testosterone

         Men –

      • CBC
      • CMP
      • PSA
      • Total Testosterone
      • Free Testosterone
      • Estradiol
      • Lipid Panel
      • 25-Hydroxyvitamin D
      • Complete Thyroid Panel – TSH, free T4, free T3, reverse T3, TPO ab, Thyroglobulin ab

         Women –

      • CBC
      • CMP
      • Lipid Panel
      • Total Testosterone
      • Estradiol
      • FSH
      • 25-Hydroxyvitamin D
      • Complete Thyroid Panel – TSH, free T4, free T3, reverse T3, TPO ab, Thyroglobulin ab

    At this point, I have found insufficient evidence that salivary testosterone measurements are a reliable form of testosterone testing. I therefore recommend serum testing only.

    It is important to point out that there is a difference between a “normal” reference range on a lab result and an “optimal” testosterone level.

    On most labs, the normal reference range for testosterone in men is about 300 to 1200. That is a HUGE range.

    Most insurance plans require 2 different total testosterone levels below 300 before they will pay for testosterone replacement therapy, whether the patient is symptomatic or not.

    But people that are having symptoms may benefit even if their testosterone level is as high as in the low 600s.

    The optimal range in men should be in the upper 1/3 of that range (I prefer 900-1100).

    In women, most labs list a normal reference range of about 15-70 ng/dl.

    However, excluding conditions such as PCOS, the optimal range for testosterone in women should be 150-250 ng/dl.

    Who Qualifies for Testosterone Therapy?

    Men –

    A man qualifies and should be considered for testosterone therapy if:

    • Serum total testosterone is <600
    • He has several of the symptoms listed above
    • His PSA is <2.5 (if >2.5, he should have a urological evaluation before being considered for therapy)
    • Any vitamin D, adrenal, or thyroid issues have been addressed
    Women

    A woman is a candidate for testosterone therapy if:

    • She has several of the symptoms listed above
    • Her total serum testosterone is <100
    • She has had a mammogram in the past year
    • Any vitamin D, thyroid, or adrenal issues have been addressed

    Treatment of Low Testosterone

    Studies have shown that testosterone therapy improves many things, including libido, quality of erections, increased lean mass, increased bone density, improved lipid parameters, reduced fat mass, and improved blood sugar control. Here are 2 examples – here and here.

    With that in mind, let’s look at treatment options.

    Men -​

    There a 3 types of testosterone therapy available for men – topical, injections, or subcutaneous pellets.

    1. Topical – Androgel®, Axiron®, Fortesta®, Testim®, Vogelxo®, transdermal patch-

    Advantages –

    • no injection or insertion procedure required
    • bioidentical testosterone

    Disadvantages –

    • messy (creams or gels)
    • expensive
    • can be transferred via skin contact to your partner if it’s not rubbed in adequately
    • can be difficult to achieve optimal levels of testosterone because of inconsistent absorption
    • not always covered by insurance

    2.  Injections – testosterone cypionate, testosterone undecanoate

    Advantages –

    • once weekly dosing
    • usually covered by insurance
    • relatively inexpensive

    Disadvantages –

    • requires weekly shots
    • testosterone level varies greatly (high at first, low late in the week)
    • may cause an elevation in red blood cells (erythrocytosis) – must be monitored
    • synthetic testosterone

    3.  Subcutaneous Pellets

    Advantages –

    • bioidentical testosterone
    • lasts 6-7 months
    • more consistent blood levels
    • lower incidence of erythrocytosis

    Disadvantages –

    • expensive
    • requires an office procedure to implant the pellets
    • not covered by insurance
    • slight risk of infection at the implant site

    Women –

    There are currently no pharmaceutical testosterone therapies for women.

    However, there are still 2 treatment options that can be extremely beneficial:

    1. Compounded bioidentical creams

    Advantages –

    • less expensive
    • multiple compounding pharmacies available

    Disadvantages –

    • inconsistent absorption

    2. Subcutaneous pellets

    Advantages –

    • lasts for 3-4 months
    • consistent blood levels

    Disadvantages

    • expensive
    • requires an office procedure to insert the pellets

    If she has a history of breast cancer, she could receive testosterone pellets with anastrazole – but no estrogen.

    Side Effects of Testosterone Therapy

    When prescribed correctly, side effects are usually minimal.  However, we are talking about a hormone, so it is possible to notice some changes. They may include:

      • Increased hair growth on the face (usually the “peach fuzz” primarily
      • Enlargement of the clitoris (women).  Reverses when therapy is stopped.
      • Erythrocytosis – increased hemoglobin and hematocrit.  Usually mild.  Treated with regular blood donation.  CBC should be monitored.
      • Mood Swings/Irritability – less common with bioidentical testosterone
      • Water Retention – rare and usually only the first few weeks of therapy.
      • Voice Changes – rare with bioidentical testosterone.  Most commonly seen with anabolic steroids.  Of note, 34% of women have voice changes as they age, so it may not be from the testosterone therapy.
      • Injection Site Irritation or Infection – rare and usually mild
      • Insertion Site Infection with Pellet Therapy – rare and usually mild
      • Excessive Estradiol Conversion – Occasionally men will have an overactive aromatase enzyme which will convert the testosterone to estradiol.  This can cause breast tenderness and mood swings.  Treated with the supplement DIM or a  medication such as Arimidex or Femara.

    Summary

    Testosterone is an important hormone in the body and is vital for well-being and energy.

    Studies show that it helps prevent heart disease, dementia, osteoporosis, and possibly breast cancer.

    When managed closely by an experienced provider, it is a safe and effective therapy for multiple symptoms associated with menopause, andropause, and the aging process.

    Now it’s your turn.

    Do you think you have low testosterone?

    Have you been tested?

    Have you ever been treated for low testosterone?

    Did testosterone therapy help you?

    Leave your comments below!

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