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Hypothyroidism and Depression – Is There a Connection?

​Is there a connection between hypothyroidism and depression?

Will taking thyroid medication reduce or even eliminate depression symptoms?

Do you still have depression even though you are on thyroid medication?

In this article, I will discuss the connection between hypothyroidism and depression, how thyroid medications can often help both conditions, and other causes of depression that you should consider…

​The ​Connection Between Hypothyroidism and Depression

​It is a​ well known fact​ in medicine that hypothyroidism is ​often associated with ​symptoms of depression. You will commonly find it listed as a symptom of hypothyroidism.  Click here for an example.

Doctors are even taught to check thyroid lab tests in any patient that presents with new symptoms of depression.

But how exactly are they connected?  We aren’t completely sure.

​However, we do know these connections:

  • ​Hypothyroidism and depression share similar symptoms.
  • Depression symptoms resolve in some people that are treated for hypothyroidism.
  • Thyroid hormone increases serotonin levels in the brain.
  • checkThyroid Releasing Hormone (TRH) is sensitive to serotonin.  Low serotonin levels may stimulate TRH production, while high serotonin levels may lead to lower TRH production.

​​Basically, depression symptoms can sometimes (but not always) be due to hypothyroidism.  If you ​treat the hypothyroidism, the depression symptoms will reduce or even resolve.

Let’s talk about depression a bit more…

​What Is Depression​?

​So what is depression anyway?  Most of us have no problem explaining the common symptoms that we call depression.

​When several people share a similar group of symptoms, ​medical organizations ​like to give it a name. This is to make things more simple, but​ it also makes it easier to bill insurance.

​The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) lists the following criteria required to diagnose depression:

  • Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

    Note: Do not include symptoms that are clearly attributable to another medical condition.

    1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation.)
    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
    4. Insomnia or hypersomnia nearly every day.
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
    6. Fatigue or loss of energy nearly every day.
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

​What ​this fails to take into account is what condition or conditions caused the symptoms in the first place!

If you are fatigued, moody, and are gaining weight since you hit menopause, should you be treated the same way as someone that just went through a divorce, or someone that is anemic​, or someone who has​ an autoimmune disease?

Of course not!

​Don’t think of depression as a ​diagnosis.  Instead, think of depression as a group of symptoms that may be caused by many different conditions.

In other words, it is a side effect of one or more other problems.  In order to properly treat the depression, the root cause must be identified and addressed.  This is the foundational principle of functional medicine.

​Possible Causes of Depression:

​1.  Hormone Imbalances

​​An imbalance in one or more hormones commonly results in symptoms of depression.

​An abnormality in these hormones should be ​one of the first things that you consider and test for when you are investigating the cause of your depression.

Examples of hormone imbalances includes menopause, low testosterone, and hypothyroidism.​

​2.  Nutrient Deficiencies

​Nutrient deficiencies ​commonly cause anemia and other conditions that result in depression symptoms.

These include B12, folic acid, and iron.

If you don’t test for them you will never know if you are deficient or not!

​3.  Gut Dysfunction

​Gut dysfunction can lead to the nutrient deficiencies listed above, it can result in a decrease in neurotransmitter production such as serotonin, and it is a primary reason why​ autoimmune disorders develop.

Most diseases in the body ​is worsened or even starts with gut dysfunction.  In fact, when I have a difficult patient and I’m not sure what to do, I start with working on their gut.

​Gut issues include lack of stomach acid, SIBO or SIFO, and dysbiosis.

​4.  Inflammatory States

​Inflammation causes a decrease in energy production in the mitochondria of the cells.  This results in fatigue, insomnia, chronic pain, and other symptoms of depression.

Examples include insulin resistance, leptin resistance, autoimmunity, and acute and chronic infections.

Most of these can be detected with proper lab testing.

​5.  Insomnia

​Lack of sleep causes mood swings, fatigue, poor concentration, and other symptoms of depression.

​6.  Alcohol Use

​Alcohol abuse ​has been shown to be associated with depression in several studies.

​7.  Stress

​Stress (particularly chronic stress) has been closely associated with depression.

​8.  Spiritual/Religious Issues

​Studies have shown that pursuing religion and spiritual beliefs can help reduce depression symptoms.  ​Guilt and conviction of not following or pursuing your personal religious beliefs could be a major source of stress that will need to be addressed.

​IT IS IMPORTANT TO REALIZE THAT it is possible and even probable that your depression is multifactorial – meaning ​it could be ​caused by several of the reasons listed above.

Treating only one of the causes may not significantly reduce your symptoms.  It will be necessary to address ALL of the causes to get the most benefit.

​Hashimoto’s and Depression

​Since up to 90% of hypothyroidism is caused by Hashimoto’s Thyroiditis, it deserves discussion as well.

As you know, Hashimoto’s is an autoimmune disorder that if left un​treated will ​slowly and gradually destroy the thyroid gland, resulting in hypothyroidism.

​One of the things that makes Hashimoto’s even more difficult than hypothyroidism is the fact that the TSH will often be in the “normal” range even though the patient may be having significant​ symptoms such as depression, constipation, fatigue, etc.

That is ​important because if the TSH is normal, very few doctors will give those patients thyroid medication, even if they have are having symptoms.  As we will discuss later in this article, thyroid medication can often greatly reduce depression symptoms.

Studies show that patients with Hashimoto’s are at increased risk of developing both depression and anxiety, even when their TSH is normal.

In fact, it appears that thyroid antibodies themselves can ​actually cause depression symptoms.

​It is therefore ​crucial to get a complete thyroid panel, including free T4, free T3, TPO antibody, and thyroglobulin antibody levels.  That will give you a​n indication of whether you are deficient in thyroid hormone​ at the cellular level and if you have ​autoimmune thyroid disease.

If someone is having depression symptoms and they have a normal TSH but a low free T3, starting a trial of thyroid hormone medication may be warranted.

They may also benefit from other Hashimoto’s therapies that help reduce antibody levels.  These can include selenium and zinc supplementation, vitamin D supplementation, LDN therapy, and others.  I discuss many of these in other blog articles on my website.

Click here to read more about ​treatments for Hashimoto’s.

​Treatment of Depression with Thyroid Medication

​Studies have shown that thyroid medication can be very effective in treating depression and depression symptoms.

It can ​reduce depression symptoms when added to an SSRI (the standard conventional treatment for depression) as shown in this study.

​Giving T3 medication has also been shown to be effective at treating depression even when patients are resistant to standard SSRI treatment.

There are also studies that show using T3 by itself is effective at reducing depression symptoms.

Of note, T3 has also been shown to be effective in treating mood disorders such as bipolar disorder, even when patients have failed multiple mood stabilizing medications.

​So why does thyroid hormone (particularly T3) help with depression?

​These studies show that there is probably a connection between mood and thyroid function.

There may even be a subset of depressed patients that actually have ​hypothyroidism that has not been identified.

There is also the possibility that some patients may have a genetic defect in one of the deiodinase enzymes that converts T4 to T3.  This may result in a decreased level of T3 circulating in the brain.

I believe that it is good medicine to have a complete thyroid panel drawn on all patients that have symptoms of depression.

If you have failed multiple depression therapies and medications, it ​would even be reasonable to try a trial of thyroid medication, especially if your free T3 level is not optimal.

The best thyroid medication to use is Cytomel or liothyronine, which is a T3 only medication.  This is the strongest thyroid medication available and does not require conversion by a deiodinase to work.

This can be done safely if th​ese guidelines are followed, which is further explained in this article:

  • ​Check TSH, free T3, and free T4 prior to starting treatment
  • Start with liothyronine 25mcg daily and titrate slowly over weeks depending on tolerance to the medication.  Most patients will need 50-150mcg daily
  • ​Recheck thyroid labs at least every 3-6 months, or more often if needed
  • checkThe goal for TSH should be in the lower limits of the reference range (or even lower at times depending on the free T3 level)
  • checkThe goal for free T3 should be in the upper limits of the reference range
  • checkIf you are menopausal, bone density should be monitored regularly

​T3 medications can sometimes cause ​side effects such as jitteriness, palpitations, excessive sweating, headache, and other symptoms.  Make sure you communicate any of these with your doctor if you are taking T3 medication.

​Some people simply cannot tolerate liothyronine due to side effects.  In those situations, a compounding pharmacy can make sustained-release T3 (SR-T3) which is typically much better tolerated.

​7 Steps to Consider if You Have Depression

​If you​ are suffering from depression, I would recommend that you follow the 7 steps below to ​help reduce or eliminate your symptoms:

​1.  Get a Complete Thyroid Panel

​Just checking a TSH level is woefully inadequate to truly evaluate your thyroid function.  Instead, I STRONGLY recommend that you ask your doctor to check all of the following tests:

​If either antibody test is >35, then a diagnosis if Hashimoto’s Thyroiditis can be made.

​If the free T3 level is < 3.5, that is an indication of hypothyroidism regardless of the TSH level, especially if you are having several symptoms of hypothyroidism.

​2.  Consider adding T3 medication to your current regimen

​Many people have issues with T4 to T3 conversion due to chronic inflammation and gut issues​.  Adding T3 to your other thyroid medication bypasses the need for the conversion step which will allow more active thyroid to reach the cells of the body, including the brain.

As little as 5-10mcg of liothyronine can be helpful.

​3.  ​Reduce your thyroid antibodies if you have Hashimoto’s

​Reducing thyroid antibodies will help in numerous ways.  This includes reducing systemic inflammation which improves thyroid conversion ​plus helps you feel better in general.  It also reduces depression symptoms directly.  Finally, it typically improves hypothyroidism which will help reduce symptoms.

​4.  ​Identify and treat and nutrient deficiencies

​These include vitamin B12, folate, and iron.  There are lab tests that test for these directly.  Treatment consists of supplements and improving gut health.

​5.  Get good sleep

​It is almost impossible to maintain good overall health if you are getting less than 7-8 hours of good sleep per night.

Here is a fascinating interview of Matthew Walker, a neuroscientist who is considered one of the premiere sleep experts in the world if you want to learn more (warning- there is ​cursing by the host in the interview).

Improving your sleep may actually be the single most potent tool that you can do to combat your depression.

​6.  Manage your stress

This is always an easy thing to say, but a hard thing to do.

Reducing your stress may need to include changing jobs, ending unhealthy relationships, and placing​ healthy boundaries in your life.

​I would also recommend adding meditation and/or yoga to your daily routine.

​7.  Address any spiritual needs

​Depending on your particular situation, this can include speaking to your pastor, priest, or spiritual advisor, and re-committing yourself to pursue a deeper meaning in your life.

​Important Note:  You may still ​need the use of an anti-depressant (at least for awhile), but finding the root causes of your depression and dealing with them directly will greatly improve​ your success in reducing or eliminating your depression symptoms.

​Summary

​Many patients that have been diagnosed with depression also have thyroid issues, including hypothyroidism and Hashimoto’s.

In many cases, adding T3 thyroid medication can reduce depression symptoms, even when their TSH is normal.

If you have depression and hypothyroidism and are taking a T4 only thyroid medication, you may want to talk to your doctor about adding T3 or changing your thyroid medication to one that contains T3.

It is important to get a complete thyroid panel to accurately assess your T3 levels and to check for the presence of Hashimoto’s.

As with most conditions, finding the root causes of your depression will allow you to directly address the issues that apply to you.

​Now it’s your turn…

Do you have a thyroid issue?  Do you also have depression?

Have you tried taking T3 medication to treat your depression?

What has worked for you?  What hasn’t worked?

Leave your questions and comments below.

Is TSH Enough

Is a TSH Enough to Test Your Thyroid?

​Most medical providers have been trained to only check the TSH when monitoring thyroid function.

​But is th​e TSH enough to ​test your thyroid?  Is it enough to monitor whether you are on the right dose or right type of thyroid medication?

The answer is a definite “no” and I will explain why in this article…

​What is TSH?

Let’s quickly review what the TSH is and what it indicates:

Thyroid cascade

​All thyroid activity actually begins in the hypothalamus of the brain​.  The hypothalamus secretes a hormone called Thyroid Releasing Hormone (TRH) which then stimulates the pituitary gland to secrete TSH.

​TSH ​an acronym for Thyroid Stimulating Hormone.  ​It’s purpose is to stimulate the thyroid gland to produce thyroid hormone.

The pituitary gland measures the level of T4 and T3 in the blood ​of the pituitary and secretes TSH in order to keep the levels of thyroid hormone in the optimal ranges.

When the body is healthy and working normally, this feedback loop works seamlessly to regulate thyroid function in the body.

As a reminder, if there are low levels of T4 and T3 in the pituitary gland, it will increase TSH secretion to try to stimulate the thyroid to produce more thyroid hormone, so the TSH level will rise.  Conversely, if there is an excess of T4 or T3, the pituitary will decrease TSH production.  The TSH level will drop or sometimes even go to zero.

The result is the TSH moves in the opposite direction of the thyroid hormone level.  If you are low in thyroid hormone, your TSH will usually go high, and vice versa.

​Remember, the TSH is ​an indicator of blood levels of T4 and T3 in the pituitary gland, which may not be the same as in the rest of the body.  This is because the pituitary has a different deoidinase enzyme than the rest of the body.

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​Thyroid Lab Tests

Prior to the 1970s, the history and physical exam were the primary tools used to diagnose hypothyroidism, Grave’s Disease, Hashimoto’s Thyroiditis, and other thyroid conditions.

​The TSH lab test was developed in 1975 and has been considered the gold standard for diagnosing and managing thyroid diseases ever since.  

​The vast majority of medical providers (doctors, PAs, NPs) are taught in their training to just use the TSH lab test to test for thyroid disorders and to monitor thyroid medications. 

If you ask ​them to do a complete thyroid​ workup to see if you have thyroid disease, they will order a TSH and ​sometimes a T4 level or TPO antibody level.  The other tests are rarely ordered, and even if they are, most providers don’t really know how to interpret them correctly.

​Conventional medicine doctors are taught this simple rule – If the TSH is high, you have hypothyroidism.  If it is low, you have Grave’s disease or you are on too much thyroid medication.  

Sounds simple, doesn’t it?  Unfortunately, evaluating the thyroid is much more complex than that.

​I personally believe that in order to truly evaluate ​someone’s thyroid health, you need to order a complete thyroid panel.  Those tests include:

​If you want more information on each of these tests, what the levels are indicating, and optimal ranges for each, read my article here.

The sex hormone binding globulin (SHBG) can also be very helpful in assessing thyroid levels in the body, especially if you are on thyroid medication.  Read more about it here.

​Common Causes of a Suppressed TSH

So ​is checking the TSH enough to diagnose and manage thyroid disorders?  No, because there are many situations in which the TSH will be falsely suppressed or at least lowered from what it really is.

Suppressing (lowering) the TSH level makes it look like the person has more thyroid hormone in their body than they really have.  As a result, this may make it look like they are on too much thyroid medication when the opposite is actually true.

Also, if they haven’t been diagnosed with hypothyroidism, this may mask their true levels and prevent the diagnosis from being made because the TSH is “normal.”

Now let’s discuss some of the situations where the TSH may be falsely low:

​1.  Pregnancy –

​The TSH can be transiently low or even undetectable in up to 20% of normal pregnant women with no other signs or symptoms of hyperthyroidism.

​2.  Medications –

​Several classes of drugs ​can suppress the TSH.  The most common ones include:

  • check​Glucocorticoids – These include oral, topical, inhaled, and injectible steroids such as prednisone, triamcinolone, dexamethasone, betamethasone, etc.
  • checkDopamine Agonists – These drugs are used primarily for the treatment of Parkinson’s Disease and Restless Leg Syndrome (RLS).  They include ropinirole (Requip), pramipexole (Mirapex), and many others.
  • checkCancer Chemotherapy –  ​Many chemotherapy drugs such as somatostatin analogs and rexinoids ​cause hypothalamic dysfunction which reduces TRH secretion ​and thus lowers the TSH.

​3.  Autoimmune Thyroid Disease (Hashimoto’s) –

​It is common practice to give Hashimoto’s patients thyroid hormone medication as a treatment for their autoimmune disease.

This is because studies show that thyroid hormone medication can reduce thyroid antibody levels even if the TSH is normal.  ​Click here, here, here, here​,  and here​ for even more studies.

This will obviously result in​ the TSH being suppressed a large percentage of the time in patients with Hashimoto’s.  However,​ it brings the T4 and T3 levels ​into the optimal range.

Which is more important?  Keeping the TSH “normal” or getting the T4 and T3 levels normal?  I believe there is a strong argument that it is more important to optimize the T4 and T3.

​4.  Chronic Fatigue Syndrome/ Fibromyalgia –

The hypothalamic-pituitary-adrenal axis is a complex system that controls many of the hormone systems of our body.  Research shows that when that system does not function correctly, it can have a major impact on the body.  That is called HPA dysfunction.

​​HPA dysfunction is ​relatively common.   ​When this system isn’t working properly, many of the hormone glands in our body – adrenal, thyroid, ovaries, and testicles – do not work normally.  This results in reduced production of cortisol, thyroid hormone, and sex hormones.

People that have HPA dysfunction ​often have low TSH levels (because of reduced production of TRH), which makes it appear on lab tests that they have adequate or even high thyroid levels in the body.  In reality, the majority of them have LOW thyroid levels, even though their TSH is in the low or normal range.

​HPA dysfunction is commonly found in people with conditions such as Chronic Fatigue Syndrome and Fibromyalgia.

If you suffer from one of these conditions or know someone who does, you may realize that many of the symptoms appear the same as hypothyroidism:

  • checkFatigue
  • checkConstipation
  • checkMuscle pain
  • checkMood swings
  • checkCold intolerance
  • checkBrain fog

​This has led some experts to believe that ​hypothyroidism at the cellular level may be one of the primary causes of fibromyalgia and chronic fatigue syndrome.

In this study, researchers gave liothyronine (T3) to patients with fibromyalgia, even though their TSH was in the normal range.  It resulted in the patients having a suppressed TSH consistent with what most doctors would call hyperthyroidism.  

However, their fibromyalgia symptoms were greatly improved, and there were no significant side effects from taking the high doses of thyroid medication.

In a follow up study, the T3 medication was discontinued, resulting in the patient’s symptoms returning. When the medication was restarted, the symptoms improved again.

​Could fibromyalgia and chronic fatigue syndrome be at least partly caused by undiagnosed hypothyroidism?  It is something that should be considered.

​5.  Mutation of the Thyroid Receptor (Peripheral Thyroid Resistance) –

​This sounds way more complicated than it really is.

​To put it simply, some people are born with a defect in the receptors in their cells where thyroid hormone attaches.  Receptors are like ​locks on the cell wall.  If the right key fits into those ​locks, it will trigger whatever function in the cell that the receptor was designed to do.

Below is a diagram of how this is supposed to work:

​However, if the lock is defective in some way, it may not work right even when the right key fits into it.

This is what happens when there is a mutation in the thyroid receptor.  The thyroid hormone may attach to it, but it may not trigger the function of that receptor like it was designed to do, at least not as efficiently as it would normally.

As a result, the cells will not be as responsive to thyroid hormone as they should be.  ​This is called peripheral thyroid resistance.

​Patients with peripheral thyroid resistance may have normal or even low levels of TSH, but their free T4 and free T3 levels will be low.  The​ amount of thyroid hormone required to normalize their free T4 and free T3 ​will often result in a suppressed TSH.

​Here is an example from a recent patient in my family practice office.

This ​ 32 year old female with a history of Hashimoto’s thyroiditis ​came to my office complaining of persistent fatigue ​despite taking Armour Thyroid 120mg daily, selenium 200mcg daily, turmeric daily, and B12 supplements.  She eats a whole food diet, exercises regularly, and gets good sleep.

Here complete thyroid panel is listed below:

​As you can see, her TSH is in the normal range.  If that was the only lab checked, you might think her thyroid level was normal.  However, both her free T4 and free T3 are very low and her reverse T3 is <15 (which we want).  Her TPO antibodies are slightly elevated.

This is typical of someone that has peripheral thyroid resistance.  It will take more thyroid medication than usual to get adequate amounts of it into her cells, most likely because she has a mutation of her thyroid receptors.

​I therefore increased her Armour Thyroid to 150mg in hopes of getting her free T4 and free T3 levels into the optimal range.  That will ​most likely​ cause her TSH to be suppressed below the “normal range,” but it will be necessary to help relieve her fatigue and other hypothyroid symptoms.

​Summary

​Only checking a TSH level is not enough to monitor the thyroid activity and function in the body.

​That is because the TSH is really only a measurement of thyroid hormone levels in the pituitary gland, which may be different than thyroid levels in the rest of the body.

Many things can cause the TSH level to be inaccurate, including some medications, autoimmune thyroid disease, chronic fatigue syndrome, fibromyalgia, thyroid receptor mutations, and even pregnancy.

In order to get a true ​assessment of thyroid activity in the body, it is important to get a complete thyroid panel and take a thorough history and physical exam.

Now it’s your turn…

​Do you have symptoms of thyroid disease but have been told that your TSH is normal?

Have you had experience treating your thyroid issue even though your TSH is normal?

Leave your questions and comments below.​

Low Dose Naltrexone for Hashimoto’s and Weight Loss

Research has shown the benefit of using low dose naltrexone for Hashimoto’s thyroiditis and other autoimmune conditions.

​If you have ​an autoimmune condition such as Hashimoto’s thyroiditis, reducing the inflammation in your body is crucial to help you feel better and lower your antibody levels.

​If you don’t lower the inflammation, it will be next to impossible to lose weight or feel as good as you can.

Lose dose naltrexone has been shown to substantially lower inflammation.  It also helps to raise endorphin levels which makes you feel better overall.

There is ​also a lot of anecdotal evidence that LDN can help ​some people lose weight.

​In this article, I will discuss LDN and what some of the research is showing about it.  I will explain how ​it can be used to potentially lower antibody levels, help with chronic pain, and ​maybe even help ​people with ​Hashimoto’s to lose weight.

Let’s get started…

More…

​What is LDN?

​LDN is short for low dose naltrexone.

Naltrexone was developed in the 1980s to treat patients with opioid withdrawal.  It is a sister drug to the well-know Narcan (naloxone).

​It is an opioid antagonist, which means it blocks opioid receptors in the brain.

When taken in doses of 50-100mg, it completely saturates the opioid receptors which prevents the person from experiencing the “high” that they normally would get from taking opioid (narcotic) medications.

It is therefore used by people in drug or alcohol rehab to help them stay off of their drug of abuse.

Dr. Bernard Bihari performed research ​in which he discovered that naltrexone in low doses helped reduce symptoms and inflammatory markers in patients with autoimmunity, cancer, and HIV.

How does LDN work?

Endorphins are our “feel good” chemicals.  They are associated with feelings of pleasure, sexuality/sensually, euphoria and pain relief. Essentially, endorphins make us feel good and give us a sense of well-being. 

Endorphins are what cause the “runners high” when ​we exercise.

Low levels of endorphins are associated with the opposite effects: physical and emotional pain (including chronic pain found in disorders such as fibromyalgia), and addiction.

Low doses of naltrexone (from here on I will refer to it as LDN) appears to increase the level of endorphins in the brain by only partially blocking the opioid receptors when the endorphin levels are at their highest (3-4am).

This signals to the body that the levels are low, so it temporarily increases endorphin production.

Endorphins appear to modulate the immune system.  Therefore, raising the endorphin levels (like LDN does), impacts the immune system in a positive way.  

LDN has also been shown to decrease inflammation in chronic pain conditions, which is why the people that have the most success using LDN typically have chronic pain as one of their main symptoms.

​Low Dose Naltrexone for Autoimmune Conditions

​People with autoimmune conditions typically have lower levels of endorphins than people without autoimmunity.

So it makes sense that if LDN raises endorphin levels, it would help someone with an autoimmune condition feel better.

​Also, autoimmune conditions are associated with an increased level of inflammation.  So the anti-inflammatory effects of LDN would obviously also help ​lower the overall inflammation in the body.

​In addition to the benefits listed above some studies have shown that the use of LDN can help to improve the immune system and reduce auto antibodies in some autoimmune conditions.

​The m​ajority of research regarding LDN that I found ​​dealt with how it can impact multiple sclerosis (MS), Crohn’s disease, and fibromyalgia.  However, it has also been used to in many other conditions.

​​Now let’s see what impact LDN has on thyroid disease (particularly Hashimoto’s).

​Low Dose Naltrexone for Hashimoto’s

To learn more about Hashimoto’s thyroiditis, read my article here.

I discuss natural treatments for Hashimoto’s in this article.

​LDN appears to improve Hashimoto’s (and all hypothyroidism for that matter) by:

​Much of the evidence of LDN impacting Hashimoto’s is anecdotal, meaning doctors and patients give their personal experiences using it.  To this point, the number of research studies are small and sporadic.

However, a quick Google search will take you to websites such as http://www.lowdosenaltrexone.org/ that will show you much of the research and patient testimonials about LDN.

I myself have had several patients that reported feeling much better when taking LDN.  Some even showed a reduction in their antibody levels.

​Does LDN Help with Weight Loss?

​The answer is yes in some studies, no in others.

​LDN should never be prescribed for the sole purpose of weight loss, but some patients have had some significant weight loss while taking it.

​It appears that LDN helps with weight loss by affecting the following:

  • Reduces Insulin Resistance – Insulin resistance is a common cause of weight gain, so it makes sense that reducing it will result in weight loss.
  • Increases Growth Hormone – Growth hormone increases lean muscle mass and increases fat burning, both of which help with weight loss.
  • ​​Modulates Appetite – LDN may help to normalize the appetite in people with a damaged metabolism which helps to match their appetite with the amount of energy they burn. https://www.ncbi.nlm.nih.gov/pubmed/9226337
  • Decreases Inflammation – High levels of inflammation cause several hormonal changes including insulin resistance, leptin resistance, poor T4 to T3 conversion, high estrogen and low testosterone.  All of these lead to weight gain.
  • Improves Sleep – Lack of sleep has been shown to increase inflammation and weight gain.  Studies show that LDN ​improves sleep in patients with sleep apnea and chronic pain syndromes

​Naltrexone can be found in a currently marketed drug for weight loss – Contrave.  However, the doses in this pharmaceutical drug are higher than the ones I recommend in this article.

​How to Take LDN

LDN is a prescription medication, so it must be prescribed by a medical professional – doctor, nurse practitioner, or physician assistant.

The vast majority of doctors have little to no experience writing it.  You may have to do your own research to find a doctor that is knowledgeable about LDN and willing to prescribe it for you.

Naltrexone is not available in most retail pharmacies in the low doses we are discussing in this article.  You will have to purchase it from a compounding pharmacy.

Insurance will not cover it.  Fortunately, it is usually less than $50 per month, so it is still affordable.

​How to Dose LDN –

​I have had the most success with LDN by starting on a low dose then stepping up the dose every 2 weeks until we get to the target dose.

My typical prescription looks like this:

Take 1.5mg daily at bedtime for 2 weeks, then 3.0mg daily at bedtime for 2 weeks, then 4.5mg at bedtime thereafter.

​Side Effects of LDN –

​LDN has virtually no side effects, which makes it a great medication to try in people with autoimmune conditions, especially those with chronic pain.

Rarely, patients may complain of vivid dreams or muscle spasms when taking the 4.5mg dose.  If that happens, reducing to 3mg usually resolves the problem.  

The patient can try to go back up to 4.5mg a few weeks later if the 3mg is not adequate to resolve their symptoms.

Remember, LDN partially blocks opioid receptors.  So if you are taking a opioid (narcotic) medication regularly, it could block the effects of your pain medication.

​Therefore, if you are on regular narcotic pain medications, ​you should ​​NOT take LDN at least until you reduce or stop your pain medications.  At the very least, you will want to take your pain medications at a different time to try to prevent the interaction.

​If you take your pain medication at the same time (or close to it) as you take LDN, it could block the effect of ​the ​narcotic medication on the opioid receptors which would in effect reverse its action.

This could result in a​ sudden increase in your pain level.  While it is not life-threatening, you could experience a lot of pain until the LDN wore off and you were able to take more pain medication.

If you are interested in trying LDN, it is critical that you give your doctor a complete list of all of your current medications.  This will help him or her to know if you can safely try LDN.

​If you have Hashimoto’s and you decide to try LDN,. it is important that you watch your thyroid levels closely.  LDN may decrease your thyroid antibody levels which could cause your thyroid hormone level to increase and cause symptoms of hyperthyroidism.

That would be a great thing ultimately, but it could be potentially dangerous at first.  You may therefore need to lower your thyroid medication dose.  

​Summary

​Low dose naltrexone is a seldom used, yet potentially helpful medication in people with Hashimoto’s and other autoimmune conditions.

Studies show that it can lower inflammation in autoimmune conditions.  It also raises endorphin levels in the brain which makes the person feel better.

​It is especially helpful in people who suffer from chronic pain, although it should not be taken at the same time as an opioid pain medication because it can block the effect of the pain medicine.

​If you are interested in trying it, you will need to find a medical provider with experience in prescribing it.  It will need to be purchased from a compounding pharmacy and insurance will not cover it.

Now it’s your turn…

Have you ever tried LDN?

If so, what was your experience with it?

Leave your comments below.

The Hashimotos Symptoms Checklist

Hashimoto’s thyroiditis is the most common autoimmune disorder.

​If you have been diagnosed with hypothyroidism, there is a high likelihood that you have Hashimoto’s and don’t even know it.

It’s important to be tested for Hashimoto’s if you have symptoms of low or high thyroid or both!

If you have an autoimmune disorder, you should also be tested for Hashimotos.

In this article, I will discuss the common symptoms associated with Hashimoto’s thyroiditis – in the early stages, middle stages and late stages – and how to make the diagnosis by showing you what tests you will need to request from your doctor.

I discuss the best natural treatments for Hashimotos in this article.

Here we go…

More…

​What is Hashimoto’s Thyroiditis?

​Hashimoto’s Thyroiditis (from now on I will refer to it as Hashimoto’s) is an autoimmune disorder. In other words, something causes your immune system to go rogue and start attacking your thyroid gland.

​It was first described by a Japanese physician, Dr. Hakaru Hashimoto, in 1912.

It is common in Japan because of their heavy fish consumption. Fish contain a lot of iodine, which when found in high amounts is a common cause of autoimmune thyroid disease.

​It is the most common autoimmune disorder in the US and its incidence is increasing rapidly.

​In fact, in my office I typically diagnose one to three new patients every week with Hashimoto’s!

​The next obvious question is – why?

​Most physicians think that it is almost purely due to our genes. However, that is only part of the story.

​In a study of identical twins with an autoimmune disorder, only 50% of their twins also had an autoimmune disorder.

​While that shows a strong link to genetics, there is obviously something else at play as well or that percentage would be higher.

There appear to be several factors that contribute to the development of Hashimotos:​

    • Genetics – family history of thyroid disease, variations in cellular thyroid components
    • Toxins – Iodine, fluoride, perchlorate, mercury, cadmium, etc.
    • Nutrient Deficiencies – Vitamin D, B vitamins, zinc, selenium, iodine
    • Infections – EBV, coxsackie virus, human parvovirus B19, herpes virus, H. pylori

​All of these factors may create a situation where the immune system attacks a part of your body (in this case, your thyroid) instead of just the foreign invaders that they are designed to attack.

How Common is Hashimotos?

Up to 10% of the US population has Hashimoto’s, and it occurs more often the older we get.

It is much more common in women. In fact, 7 women are diagnosed for every 1 man that is diagnosed. Some experts estimate that it may be present in up to 20% of women!

It is more commonly seen around the times of puberty, pregnancy and menopause, which seems to show that hormone fluctuations may play a role in the development of Hashimotos.

If appears to be more common in Caucasians and Japanese individuals.

So what are the common symptoms of Hashimotos?​

Hashimoto’s Symptoms Checklist

Hashimoto’s is by far the most common cause of hypothyroidism, or low thyroid. In fact, some researchers believe up to 90% of hypothyroidism is due to Hashimoto’s!

Hashimoto’s causes hypothyroidism because the antibodies produced by our confused immune system cause inflammation in the thyroid cells. That inflammation will damage the cells and eventually destroy them.

2 factors cause the variation in symptoms in Hashimoto’s:

    • Fluctuations in thyroid hormone levels
    • The level of inflammation from the autoimmune condition

The level of inflammation can wax and wane, which can cause the severity of symptoms to vary as well.

Think of an arthritic knee.  At times the inflammation is not too bad so the symptoms are mild.  At other times, the inflammation is increased which also worsens the symptoms.​

At times, the inflammation can cause an increased release of thyroid hormone which can result in symptoms of hyperthyroidism.

That is because as the thyroid cells are being destroyed, stored hormones can be released into the blood stream, causing a toxic load of thyroid hormone.

Enough thyroid cells will eventually be destroyed that the thyroid will no longer be able to produce adequate thyroid hormone to keep up with the demands of the body. Hypothyroidism then develops.

By the time that most Hashimoto’s patients are diagnosed, they have probably had the condition for years.

However, the thyroid was not damaged early in the disease to the point of causing enough symptoms to make the patient seek medical help. Or they may have blamed the symptoms on something else.

Early Symptoms of Hashimoto’s

Early symptoms of Hashimoto’s are typically mild symptoms.  These include:

    • Mild fatigue
    • 5-10 pounds of weight gain
    • Depressed mood
    • Difficulty focusing
    • Dry skin, dry and brittle hair, nonspecific rashes
    • Mild constipation
    • Mild fluid retention (especially in the face and lower extremities)
    • Voice changes or the sensation of throat swelling
    • Reduced ability to sweat
    • Mild joint pain and muscle aches
    • Mild to moderate changes in the menstrual cycle

If you have any of these symptoms, it is important that you get your thyroid antibody levels checked.

At this point, if the inflammation is reversed, it is possible to avoid permanent damage to the thyroid gland.

Hyperthyroid Symptoms

Over the next several years, people with Hashimoto’s can fluctuate between hyperthyroidism and hypothyroidism.

This is because the thyroid antibodies will attach to the thyroid gland and cause increased inflammation.

This inflammation may trigger the thyroid to release a surge of thyroid hormone which will cause symptoms of hyperthyroidism.​  These symptoms can be even worse if the person is already on thyroid medication.

Symptoms that indicate an increased level of thyroid hormone include:

    • Hot flashes or episodes of heat intolerance
    • Jitteriness
    • Symptoms of anxiety
    • Fatigue or big swings in energy level
    • Insomnia
    • Facial flushing
    • Heart palpitations or racing pulse
    • Weight loss or weight gain

Not all Hashimoto’s patients will have these episodes of hyperthyroidism.

Some folks just have a progressive decline in thyroid function and have classic symptoms of hypothyroidism.

Symptoms of Advanced Hashimoto’s

Eventually, if the Hashimoto’s isn’t found and addressed, all thyroid stores will be depleted and hypothyroid symptoms will occur.

The typical symptoms of a patient with advanced Hashimoto’s include:

    • Extreme fatigue/exhaustion
    • Moderate weight gain (usually 20-30 pounds)
    • Hair loss or hair thinning
    • Mood changes, typically depression
    • Menstrual irregularities
    • Chronic and debilitating muscle or joint pain
    • Chronic constipation, other GI issues such as gas/bloating, SIBO, acid reflux, low stomach acid

I discuss a more extensive list of symptoms of hypothyroidism in my article found here.

Even in the advanced stages, patients can still have “flares” during which their symptoms are much worse.

These symptoms can include worsening fatigue, jitteriness, sudden weight gain, brain fog, and GI symptoms.

If this happens, it is important to see your doctor for further evaluation and labwork.

Your healthcare provider may also notice an enlarged thyroid gland on exam (called a goiter). The majority of goiters are caused by Hashimoto’s.

In fact, people with Hashimoto’s are 3 times more likely to develop thyroid cancer than people without Hashimoto’s.

If your thyroid is enlarged, you need to see a doctor to get a definitive diagnosis. Enlargement can also be caused by other conditions, including thyroid cancer.

How to Diagnose Hashimotos

​Hashimotos can be diagnosed in 3 ways:

    • Positive thyroid antibodies
    • Positive thyroid ultrasound
    • Positive thyroid biopsy (fine needle aspiration)

The vast majority of patients are diagnosed with Hashimoto’s by finding elevated levels of thyroid antibodies on blood testing.

I will occasionally discover an enlarged thyroid on physical exam, but that is usually only a handful of times per year.

Get a Complete Thyroid Panel​

Hashimoto’s will not be diagnosed without a complete thyroid panel.

A TSH, which is typically the only thyroid test ordered by most conventional doctors, will not diagnose autoimmune thyroid disease. The TSH typically will not become permanently elevated until the Hashimoto’s has become advanced.

A Complete Thyroid Panel Includes:

  • TSH
  • free T4
  • free T3
  • reverse T3
  • TPO antibodies
  • Thyroglobulin antibodies

​90% of Hashimoto’s patients have elevated TPO antibodies. 80% have elevated thyroglobulin antibodies.

If either the TPO or thyroglobulin antibodies are >35 ng/ml, the diagnosis of Hashimoto’s can be made.

A small percentage of Hashimoto’s patients will have normal antibody levels, but their ultrasound will be abnormal or their thyroid biopsy will show evidence of the disease.

It is also recommended that all patients with elevated thyroid antibodies should have a thyroid ultrasound. If it is normal, the ultrasound should be checked every 2 years. If it shows evidence that the thyroid is growing, a repeat ultrasound should be performed every 6 months.

Evaluate Inflammation

It is also a good idea to monitor the level of inflammation in your body if you have Hashimoto’s.

Inflammation itself can worsen thyroid function by reducing T4 to T3 conversion.​

It can also worsen insulin resistance and adrenal dysfunction.

All of these issues can lead to worsening fatigue, weight gain, and other symptoms that can worsen the hypothyroid symptoms that are already present.​

Inflammation can be evaluated by checking the following lab tests:

    • Erythrocyte Sedimentation Rate (ESR)
    • C-Reactive Protein (CRP)
    • Ferritin

If these levels are elevated, it is a sign that inflammation is increased in the body and your thyroid gland may be under assault and being damaged.

Look For Other Autoimmune Conditions​

One study showed that up to 5% of patients with Hashimoto’s have celiac disease. Another study showed up to 50% of celiac patients have Hashimoto’s.

Therefore, it is recommended that all patients who are diagnosed with Hashimoto’s should be tested for celiac disease.

Statistically, if a patient has an autoimmune disorder such as Hashimoto’s, they have a higher risk of having a second autoimmune disorder. These include Type I diabetes, multiple sclerosis, rheumatoid arthritis, lupus, celiac disease, Addison’s disease, and others.

Consider Hashimoto’s If You Have a Mood Disorder​

Many Hashimoto’s patients may be misdiagnosed with mood conditions such as depression, anxiety, and bipolar disorder.

One study also showed that people with these conditions have a higher prevalence of anti-thyroid antibodies.

Because of this, any person with anxiety, depression, or other mood disorders should have a complete thyroid panel checked.

Instead of taking anti-depressants or anti-anxiety medications, they may need their thyroid issue treated!

So I Have Hashimotos.  What is My Prognosis?

Most conventional doctors are taught that Hashimoto’s is an irreversible, inevitable disease that will eventually kill the thyroid.

They are taught that patients should just have periodic thyroid levels checked and thyroid medication should be prescribed once the levels are abnormal and the patient becomes hypothyroid.

They don’t believe anything else can be done.

Of note, one study showed that up to 20% of patients with Hashimoto’s can have spontaneous recovery of their thyroid function.

Just like in other autoimmune diseases, I believe (and the literature supports this belief), that the course of Hashimoto’s can be slowed or even reversed with proper lifestyle interventions.

I will discuss many of those interventions in my treatment article found here.

Hypothyroidism does not have to be inevitable in Hashimoto’s!

Summary

Hashimoto’s thyroiditis is the most common autoimmune disorder.

90% of all hypothyroidism may be due to Hashimotos.​

Early in Hashimoto’s, the symptoms may be mild and not recodgnized as being due to a thyroid issue.

In some patients, their symptoms may vacillate between hypothyroid and hyperthyroid because of fluctuations in inflammation levels. ​

If Hashmoto’s has been present for years, ​it will eventually destroy the thyroid gland which will cause typical symptoms of hypothyroidism.  Thyroid medication will be required.

Hashimotos is typically diagnosed by having a TPO antibody and/or thyroglobulin antibody level >35, or with a positive thyroid ultrasound or biopsy.

Inflammatory markers should also be tested.

All patients that are diagnosed with Hashimotos should have a thyroid ultrasound and be tested for celiac disease.

With appropriate lifestyle interventions, the progression of Hashimoto’s can be slowed or even reversed.

Now it’s your turn…

Have you been diagnosed with Hashimotos?

What symptoms did it cause in you?

Leave your comments below.

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The Best Hashimoto’s Thyroiditis Natural Treatments

What are some Hashimoto’s thyroiditis natural treatments?

What can you do to get rid of many of the symptoms of Hashimoto’s or even possibly make it go away altogether?

In this article, I will walk you through the most effective natural treatments for Hashimoto’s.

This will include common nutrient deficiencies that are present in Hashimoto’s and the supplements you should consider using.

I will also discuss the most common food sensitivities and dietary recommendations for Hashimoto’s.

Finally, I will touch on infections and toxins that may trigger or worsen Hashimoto’s.

Let’s get started…

More…

ConsiderNutrient Deficiencies

Many nutrients are essential for normal thyroid and immune system function. A deficiency of them sets a person up for the development of conditions such as Hashimoto’s and other autoimmune diseases.

In our affluent society where there is generally no lack of food availability, how could anyone be deficient in nutrition? That doesn’t seem possible.

Several things play a role (taken from Hashimoto’s Thyroiditis Root Cause by Izabella Wentz):

  • Modern farming techniques Non-organic farming typically involved using fertilizers and pesticides. Also, a typical field is used year after year to plant the same crop, which will deplete the soil of nutrients.
  • Standard American DietThe typical diet eaten by most Americans contains highly processed, nutrient-deficient food.
  • MedicationsMillions of people take medications on a daily basis that affect the absorption of nutrients in the gut and alter the beneficial bacteria in our digestive system that are essential for normal digestion of food. These include acid blockers (omeprazole, ranitidine, etc.), antibiotics, and even oral birth control pills.
  • Food SensitivitiesMany people are sensitive to certain foods and may not even know it. The most common are dairy and gluten. These sensitivities cause an increase in inflammation of the digestive tract which can affect it’s ability to absorb nutrients.
  • Hidden InfectionsPatients may have infections they don’t even know they have. These include H. pylori, intestinal parasites, etc. All can increase inflammation and alter the normal gut flora which can impair nutrient absorption.
  • Restrictive DietsDiets that are not nutritionally balanced can do more harm than good.
  • HypothyroidismYes, being hypothyroid can itself cause nutrient deficiency by slowing the emptying of the stomach, reducing the amount of acid in the stomach, and even causing an imbalance of gut bacteria.

Common Nutrient Deficiencies in Hashimoto’s

Selenium

Studies have shown that low levels of selenium can serve as a trigger for the development of Hashimoto’s.

You can become deficient because of gut issues (inflammation, altered gut flora) or even from gluten-free diets.

Symptoms of selenium deficiency include anxiety and hair loss.

Taking selenium will reduce thyroid antibody levels and anxiety symptoms.

Studies have shown that selenium supplementation is helpful even if the selenium levels are normal.

How to Supplement with Selenium

Why I Like It

May reduce antibodies in patients with Hashimoto’s

Also acts as an  anti-inflammatory

May help reduce anxiety symptoms

Helps boost T4 to T3 conversion (helpful in those with high reverse T3)

Who Should Use It

    • Patients with hair loss or hair thinning
    • Patients with a known thyroid disorder and hair loss
    • Patients with other nutrient deficiencies like zinc or iodine
    • Patients who frequently take acid blockers for acid reflux
    • Patients with other GI related issues (IBS, gas/bloating, IBD)
    • Patients also taking zinc

How to Use

    • Take 200-400 mcg per day (do not exceed 400 mcg daily)

My Recommended Brand and Product

Get Selenium Here

Iron/Ferritin

Ferritin is the iron storage protein. It is essential for transporting thyroid hormone into the cells.

Lack of ferritin causes hair loss, fatigue, cold intolerance, and shortness of breath.

Ferritin levels should be checked in all Hashimoto’s patients, especially those that are experiencing hair loss.

The optimal ferritin level for thyroid function is 90-110 ng/ml.

Iron levels can best be restored by eating foods high in iron such as meats, especially organ meats. Vitamin C also helps with iron absorption.

Sometimes, supplementation may be necessary at least for awhile.​

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

B Vitamins

B vitamins are commonly deficient in Hashimoto’s patients, especially B12.

This is due primarily to low stomach acid which is common in Hashimoto’s.

Signs and symptoms of deficiency include fatigue, grooves in your tongue, and an elevated homocysteine level (which should be less than 6 umol/L.

All Hashimoto’s patients should have their B12 level checked.  If it is <1000, they should consider supplementing.​

By the way, over 60% of the population has a gene mutation in the enzyme MTHFR, which can impair the body’s ability to metabolize B vitamins. This can cause the homocysteine level to become elevated, which is a risk factor heart disease and other conditions.

It is important for these patients to take a methylated form of B vitamins, especially folic acid. If you don’t know if you have the gene mutation, either get tested or take a methylated B vitamin. My recommended brand can be found here.

You should also consider supplementing with B12 shots.

Many Hashimoto’s patients have GI issues that can impair the absorption of nutrients.

Completely bypassing the GI tract by giving it in shot form is the best way to ensure that the B12 is absorbed as much as possible.​

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 for best results.

Zinc

Zinc is essential for normal thyroid function. Most patients with thyroid disease are deficient.

Zinc is not stored in the body, so a consistent daily intake is required to maintain levels.

Zinc deficiency can be detected by a low alkaline phosphatase level, which is a routine lab tests run by most labs. It’s optimal range should be 70-90 U/L.

How to Supplement with Zinc

Why I Like It

Many people are deficient in zinc

May help with T4 to T3 conversion

May increase cellular sensitivity to thyroid hormone

Has anti-inflammatory effects

How to Tell if You Need It

    • If you have Hashimoto’s and hair loss
    • If alkaline phosphatase is < 70

How to Use

    • Take 30-60 mg daily (do not take more than 60 mg)

My Recommended Brand and Product

Get Zinc Here

Vitamin D

Vitamin D is essential for normal thyroid function.

Studies show that over 40% of the population is deficient. However, that study defined deficiency as a 25-hydroxy vitamin D level of less than 20 ng/ml. Other studies show that a level of 60-80 ng/ml is needed for optimal thyroid function. When using those levels as “normal,” over 90% of the population is deficient.

Low levels of vitamin D have been shown to increase the risk for development of Hashimoto’s.

All Hashimoto’s patients should have their 25-hydroxy vitamin D level checked yearly.

Most patients need at least 5000u per day of vitamin D3 with K2 such as this one.

How to Supplement with Vitamin D3

Why I Like It

Most people are deficient in Vitamin D

May help with T4 to T3 conversion

Deficiency increases risk for Hashimoto’s

Has over 200 functions in the body

How to Tell if You Need It

    • 25-hydroxyvitamin D level < 50

How to Use

    • If < 40 take 10,000u daily for 90 days, then drop to 5000u daily.
    • If > 40, take 5000u daily
    • Check level yearly

My Recommended Brand and Product

Get Vitamin D3 Here

Iodine

Iodine can be listed under both toxins and essential nutrients for normal thyroid function.

That’s because a deficiency of iodine is the world’s leading cause of hypothyroidism.

However, excessive amounts of iodine can increase the risk of the development of Hashimoto’s.

This means iodine has a small therapeutic window – Too little is bad, but too much is also bad.

Hashimoto’s was rarely seen in the United States until the nationwide salt iodinization program began in 1924.

​Some people fear that using iodine in patients with Hashimoto’s may make the condition worse, and it can – but usually only in patients with other thyroid issues and those on medications that are known to interfere with thyroid function (lithium, amiodarone, etc.).

In the majority of cases, and if used correctly, iodine can be safe to use in patients with both hypothyroidism and Hashimoto’s.

Taking the iodine with selenium can help prevent any negative effects – such as an increase in thyroid antibodies that has been shown to occur in some studies.

Supplementing with both selenium and iodine has been ​shown to reduce TSH and result in an increase in peripheral thyroid hormones and may protect against an increase in thyroid antibodies in patients.

Patients with thyroid issues like Hashimoto’s usually tolerate iodine, but it must be accompanied with normal and optimal selenium and iron levels.

If you decide to take iodine, make sure your thyroid antibodies are checked regularly by an experienced provider.

How to Supplement with Iodine

Why I Like It

May improve thyroid function

May help detox some substances

If deficient with improve other systemic problems

Generally works very quickly in deficient patients

Who Should Use It

Supplementing with iodine can be difficult.

If possible I recommend testing your urinary excretion of iodine prior to supplementation.  If you decide not to test yourself then start out at very low doses (~200-300mcg per day) and slowly increase the dose based on your symptoms.

How to Use

    • Take 200-300 mcg per day and slowly titrate dose based off of symptoms – discontinue if you experience any negative side effects and seek professional help
    • It is safest to take it with selenium 200-400 mcg daily

My Recommended Brand and Product

For low doses start with 200-300 mcg of kelp caps and titrate your dose as tolerated:

Get Iodine Here (low dose)

For higher doses I recommend liquid iodine with a combinations of both iodine and iodide:

Get Iodine Here (high dose)

Look For Food Sensitivities

So, what foods should you eat? What foods should you avoid?

Gluten

Everyone by now how has heard about this mysterious gluten molecule that seems more dangerous than a nuclear weapon. Why is it so bad?

Multiple studies such as this one have shown a strong link between Hashimoto’s and gluten intolerance.

There is a higher incidence of Celiac Disease in Hashimoto’s patients. However, even people that test negative for gluten antibodies can still react to it.

Some researchers estimate that up to 1/3 of the population has some degree of gluten sensitivity.

It is believed that gluten looks similar to parts of the thyroid gland. This causes the immune system to make antibodies against the thyroid because of molecular mimicry like I discuss​ under Consider Infections below.

Gluten also worsens intestinal permiability (leaky gut).

Gluten is a component of wheat, so it is present in pasta, breads, crackers, etc. Gluten is also frequently used as a filler in other foods and is commonly found in things such as shampoo, makeup, etc. It is even present in some medications!

The most simple and cost-effective way of determining if you are gluten sensitive is using an elimination diet. In other words, remove it completely from your diet for about 3 weeks. After the 3 weeks are over, re-introduce it into your diet. If you have any kind of reaction – nausea, diarrhea, dizziness, fatigue, etc. – you are most likely gluten sensitive.

To top it off, the immune response to gluten can last for up to 6 months after eating it!

That is why it is critical to follow a gluten-free diet 100%. Anything less may not reduce the thyroid inflammation adequately to prevent the Hashimoto’s from killing it.

There is enough data for me to feel confident in recommending a gluten-free diet in all Hashimoto’s patients.

Actually, I believe there is ample evidence to suggest that everyone should be gluten-free.

This has fortunately gained enough traction in society that becoming gluten-free is much easier than it was just a few years ago.

A quick internet search will uncover multiple websites with recipes and other information to help you in this journey. Many grocery stores also have sections featuring gluten-free products.

If you want to read more about gluten, I highly recommend the book Wheat Belly by Dr. William Davis.

By the way, removing gluten from my diet was the single most effective therapy that brought me back to a life of health.

Other Food Sensitivies

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

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

Tomatoes, potatoes, peppers, corn, citrus, beef and pork can also cause problems in some people.

Your doctor can order a basic food allergy panel which will check most of these common food allergies. If you test positive, you know that you need to remove that food from your diet.

Remember, however, that you may still be sensitive to that food even if you don’t have antibodies to it.

There are also tests available to check for IgG antibody levels to various foods.

As I discussed under gluten, the most simple way for you to find out if you have any food sensitivities is to use 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.

Get On An Anti-inflammatory Diet

The goal for Hashimoto’s is to reduce the level of inflammation in the body, especially the thyroid.

One of the best ways of accomplishing that goal is to remove inflammatory foods.

The Most Inflammatory Foods

  1. Gluten
  2. Sugar
  3. Dairy
  4. Vegetable oils
  5. Artificial sweeteners and preservatives
  6. Saturated fats

Removing these things from your diet will have a HUGE impact on your health, including your thyroid health.

There are several popular diets that are excellent at removing these things and giving you instruction on what you can eat.

The best diets for Hashimoto’s are:

Any of these diets will have you eating clean, whole foods and reducing your systemic inflammation quickly.

It can take several months for the inflammation to reduce substantially, so don’t give up!​

Remember, even though you start one of these diets, you may still need to do an elimination diet to help you determine what food sensitivities you have.

Get Your Gut Healthy

1.  Betaine HCL with Pepsin

​Advertisements from pharmaceutical companies make it seem like almost everyone has too much stomach acid.

In reality, it’s exactly the opposite.

Most patients have low levels of stomach acid.  That includes almost all Hashimoto’s patients.

When stomach acid is low we can’t absorb nutrients as well.

The lack of acidity also makes it easier for bacteria and other organisms to survive their passage through the stomach and set up residence somewhere in the body, causing an infection to develop.

Adding betaine hcl with pepsin can help increase the stomach acid to optimal levels and relieve many of the reflux and other GI symptoms you may be having.​

​Betaine HCl and Pepsin should be taken after a protein-rich meal, starting with one capsule per meal, at the end of the meal. The dose should be increased by one more capsule at each meal until symptoms of too much acid are felt (burping, burning, warming in the stomach region, etc.). At that point, you will know that your dose is one capsule less than what resulted in symptoms.

​If you get burning after taking it, drinking a mixture of one teaspoon of baking soda in a glass of water will reduce these temporary symptoms.

Don’t take betaine hcl is you have a history of ulcers or if you are taking an NSAID or steroid medication.​

My favorite brand of Betaine hcl with Pepsin is this one.​

​2.  Probiotics

Most hypothyroid and Hashimoto’s patients have some degree of intestinal dysbiosis (usually due to decreased kinetic movement of the bowels from lack of thyroid hormone).

​As a result many Hypothyroid patients are prone to develop a condition known as Small Intestinal Bowel Overgrowth (or SIBO).

Patients with SIBO tend to get gas and bloating with lactobacilli-based probiotics but can usually tolerate soil-based probiotics well.​

That’s why it’s usually best for most Hashimoto’s patients to use a good soil-based probiotic such as this one.​

ConsiderInfections

Various infections have been implicated in the development of autoimmune diseases, including Hashimoto’s.

There are 2 main theories of how these infections trigger the immune system to attack the thyroid gland.

  1. Molecular Mimicry – In this theory, bacterial cells or other microbes look very similar to cells within our body (such as thyroid cells). Our immune system produces antibodies to kill the microbes, but since they look like our own cells, the end result is the antibodies produced attack the cells in our body instead of just the microbes.
  2. Bystander Effect – Another theory suggests that the microbes (especially viruses) take up residence in the cells of our body. In the process of killing the microbes, our immune system also damages the cells in our body where the viruses are residing.

The most common organisms associated with Hashimoto’s are Mycoplasma, Candida, and Epstein-Barr virus.

Other organisms implicated include Helicobacter pylori, Lyme disease, Yersinia, Coxsackie virus, and Hepatitis C. Intestinal parasites may also be present.

Low stomach acid, nutrient deficiencies, altered gut bacteria, and an impaired immune system all contribute to Hashimoto’s patients having an increased risk of having any of these infections.

If you aren’t improving despite following a strict diet and restoring any nutrient deficiencies that are present, that is the time to start looking for hidden infections or toxins.

Avoid Toxins

Unfortunately, our world is full of chemicals and other substances that can be harmful to us, including our thyroid gland.

An example of these are the endocrine disruptor chemicals (EDC). They are everywhere and are impossible to completely avoid.

Some types of them are even stored in the fat calls of our body. This is bad because if we start burning fat as an energy source (which happens in the diets listed above), many of these stored chemicals are released. They can worsen thyroid function and stop weight loss.

An example of an EDC that is controversial is fluoride. It has been added to many water supplies since the 1940s because it reduces the incidence of tooth decay. However, fluoride can be toxic to thyroid cells and can cause inflammation and even thyroid cell death.

There are a few common sense things that we all can do to at least reduce the amount of exposure to endocrine disruptor chemicals:

  • Drink filtered water
  • Drink from glass or metal containers (avoid plastic bottles)
  • Install a shower head filter such as this one.
  • Use a non-fluoride toothpaste.
  • Avoid using herbicides on your lawn or plants (Google “Homemade Weed Killer” for safe alternatives).

You can also help your body get rid of toxins by doing one simple thing – Sweat!

Sweating is one of our body’s best detox mechanisms.

Regular time in a sauna and high intensity interval training (HIIT) are 2 excellent ways of activating our sweat function.

Summary

There are several natural treatments that you can do to improve your Hashimoto’s symptoms.

Considering potential nutrient deficiences and taking targeted, high-quality supplements is critical.

It is also very important to identify any food sensitivities that you may have by utilizing the elimination diet.

Increasing your stomach acid and taking a good probiotic can help to increase nutrient absorption and improve your immune system.​

Infections and toxins can also be playing a role in your autoimmune condition.

Now it’s your turn.

Are you appropriately supplementing for any deficient nutrients?

Do you have any food sensitivities?

Have you identified any infections or toxins that may be worsening your Hashimoto’s?

Leave your comments below!

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