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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.​

How to Use Liothyronine (T3) in Hypothyroidism

​Liothyronine (T3) is ​the most potent thyroid hormone that you can take.

It is rarely prescribed by most doctors, which is unfortunate, because it can significantly improve your hypothyroid symptoms and overall quality of life.

The symptom improvements can include ​improved energy, weight loss, and even a reduction in depression.

​Learn who could benefit from using liothyronine, how to use it safely, and lots more in this article…

More…

What is Liothyronine?

​In order to understand liothyronine, it is important that you ​understand the basic physiology of the thyroid. You can read more in depth about it by clicking here.

Liothyronine is T3.  T3 is one of the 2 main circulating thyroid hormones in your bloodstream.

T4 is the inactive thyroid hormone.  The vast majority of hormone made by the thyroid gland is T4.

T4 itself ​has no activity in the body.  In order for it to be​come an active hormone, it must be converted into T3​.  An iodine molecule is cleaved off of the T4 by an enzyme called a deiodinase, which ​results in the production of T3.

T4 can be looked at as the storage reservoir for thyroid hormone in ​your body.  When your body needs more active thyroid hormone, it can convert the T4 that is circulating in the blood into active T3.

​By understanding that T4 is the inactive form of thyroid and T3 is the active form, it then makes sense why ​oral T3 medication is much more potent than oral T4 medication.  In fact, it is about 3-4 times more potent.

Liothyronine vs. Levothyroxine

​If Liothyronine is so powerful, then why don’t more doctors prescribe it?

​Most doctors simply were not taught how to prescribe T3 medication and manage patients that are taking it.  They ​were also not taught which labs need to be monitored and how to interpret those test results.

I ​was personally NEVER taught about T3 medications in my many years of training.  I have had to learn about it myself through attending multiple medical conferences, reading tons of literature, and asking doctors with experience ​prescribing it how they use it.

It is simply assumed by most doctors that all patients have no issues with converting T4 to T3.  If that was the case, every patient could just take a T4 only medication such as Synthroid, levothyroxine, or Tyrosint and it would seamlessly be converted to T3 when the body needed it.

Wouldn’t that be easy?

However, most people with thyroid issues have a reduced ability to convert T4 to T3.  Instead, much of the T4 is converted into the anti-thyroid metabolite reverse T3 which results in a condition called reverse T3 dominance.  This is usually due to chronic inflammation in the body and/or a deficiency of nutrients such as iodine, selenium, or zinc.

​That is why you may be on a ​good dose of a T4 only medication which results in a normal ​TSH and T4 level, yet you still have symptoms of hypothyroidism.

In those situations, when used and monitored properly, liothyronine can be a safe and extremely effective medication to treat your hypothyroidism and improve your symptoms.

One study showed that replacing T4 with T3 resulted in weight loss and greater thyroid action on lipid metabolism, without an increase in side effects.

Who Should Use Liothyronine?

​Not everyone who takes thyroid medication necessarily needs to take liothyronine.

​Besides having hypothyroidism, if you are otherwise healthy, energetic, and feel great, your conversion of T4 to T3 is probably adequate and you may not need to change from your T4 only medication.

Now, for the other 99% of you (ha!), you may want to get a complete thyroid panel so that you can truly assess the T4 and T3 levels in your body:

​You should also consider getting a sex hormone binding globulin level (SHBG), which can also help give you an idea of the thyroid levels in your body (if you are on oral birth control pills or estrogen or if you smoke, this test will not be helpful).

​If your reverse T3 level is >15, your free T3 level is ​<3.5, and/​or your SHBG level is <20 in men or <60 in women (who aren’t taking oral estrogen), then your T3 level is inadequate and you ​may want to consider adding T3 in some form to your regimen.

Below is a general list of people who may need to add T3 to their thyroid medication regimen:

  • checkPatients with low serum levels of free T3 (<3.5)
  • checkPatients with high levels of reverse T3 (>15)
  • checkPatients with “normal” TSH and T4 levels but still remain symptomatic despite taking T4 only thyroid medication
  • checkPatients with chronic inflammatory conditions such as an autoimmune disease, insulin resistance, and leptin resistance
  • checkPatients that have persistent difficulty with weight loss
  • checkPatients with treatment resistant depression and treatment resistant bipolar disorder

​This is by no means an exhaustive list, but it includes the majority of patients that m​ay benefit from taking T3.

​What about Natural Dessicated Thyroid (NDT)?

​If you are currently taking a T4 only medication (Synthroid, levothyroxine, or Tyrosint), changing to an NDT medication such as Armour Thyroid, NP Thyroid, or Nature-throid may be the easiest ​thing to try to increase your T3 level.  In fact, that is usually the first thing I will do for patients.

NDT is about 80% T4 and 20% T3.  While that is certainly better than a ​medication with 100% T4, that may still be too much T4 which ​could result in a high level of reverse T3.

If​ you are taking an NDT medication and your reverse T3 levels are too high and your free T3 levels are too low, you may need to reduce your NDT dose (at least temporarily) and add a small dose of liothyronine in order to “flush out” the reverse T3 which will allow the T3 ​levels to rise to optimal levels.

Liothyronine for Weight Loss

​Liothyronine may cause weight loss but it should NOT be used as a weight loss medication.

​If used for weight loss in patients without thyroid dysfunction, it could cause some unpleasant and even dangerous side effects.

However, liothyronine may help with weight loss in patients with hypothyroidism.

T3 may cause more weight loss than T4 because of how it interacts with fat cells and other hormones in the body.

T3 directly increases mitochondrial energy production and increases thermogenesis and fat burning potential.

Liothyronine for Depression

​Liothyronine can also reduce symptoms of depression.

Low thyroid levels (hypothyroidism) are known to commonly result in symptoms of depression.

What you may not know is that adding liothyronine to an antidepressant ​can improve mood and cognitive function even when the thyroid function is normal.

The exact mechanism is not fully understood, but it is believed that some patients with depression may have subclinical hypothyroidism that is not bad enough to be detected on standard lab tests but still causes typical symptoms of depression.

Therefore, by treating those patients with liothyronine, it may correct those subtle thyroid abnormalities in the brain which will help resolve the depression symptoms.

T3 has also be shown to increase the receptor sensitivity to serotonin and increase the synaptic concentrations of serotonin.

Since the most commonly used antidepressants are only successful in treating depression in about 50% of cases, the addition of liothyronine ​is a viable option to consider, especially in “treatment resistant” cases.

If you are on a T4 only thyroid medication and are still suffering from depression, adding liothyroinine to your T4 medication may significantly improve mood and neuro​psychological function.

​How to Raise T3 Levels

​The whole point of even ​discussing liothyronine is because we want to raise the ​active thyroid levels (T3) in the body to optimal levels.

​Taking T3 medication (liothyronine) will obviously accomplish that goal.  There are ​also some natural things that should be considered that will result in increased levels of T3.  Let’s discuss those ​as well as how to take ​liothyronine…

​1. Naturally Increase T4 to T3 Conversion

​The conversion of T4 to T3 is dependent on a few nutrients.

​It is common for people to be deficient in these nutrients because they may be lacking in their diet or they may have gut issues such as leaky gut that reduce the absorption of the nutrients.

Some of the most important nutrients include:

  • checkZinc – Zinc has been shown to improve conversion of T4 to T3, acts and a strong anti-inflammatory, and reduce oxidative stress.  Zinc deficiency is VERY common in the US. Standard zinc supplementation is also inadequate because it does not have zinc bound to picolinic acid (which is the most absorbable form of zinc).  Doses of 30-60mg per day are recommended.  It is important to take it with selenium.
  • checkSeleniumSelenium can improve thyroid conversion, act as an anti-inflammatory, and help balance the immune system.  It is also very helpful if you have an autoimmune thyroid issue such as Hashimoto’s.  Doses of 200-400mcg per day are recommended. Best if taken with zinc.

​2. Naturally Lower Reverse T3 Levels

​Another way that you can raise T3 levels and improve its function is to lower reverse T3 levels.

Remember, reverse T3 is the anti-thyroid metabolite that binds to thyroid receptors on the cells but blocks their function.

By reducing the amount of reverse T3, it will in effect improve T3 function.

So how do you do it?  Address the issue that is causing the reverse T3 level to be increased in the first place.

Easier said than done, but below is a list of common issues that result in elevated reverse T3 levels:

  • checkReduce Inflammation – Inflammation from any cause will increase reverse T3 levels and reduce thyroid function.  Checking ESR and CRP lab tests will indicate how much inflammation is present.  If those test are elevated, consider taking anti-inflammatory supplements such as tumeric, fish oil, and quercetin+bromelain.
  • checkFix Your Gut – ​Treating conditions such as leaky gut or SIBO are essential to improve your thyroid function.  Up to 20% of thyroid conversion occurs in the gut, plus absorption of nutrients that are vital to normal thyroid function may be impaired.  About 50% of thyroid patients have SIBO/SIFO and don’t even know it.  Read more about it here.
  • check​Lower Your Insulin Level – High insulin and sugar levels inhibit the ​T4 to T3 conversion process and ​contribute to weight gain.  If your fasting insulin is >5, you most likely have insulin resistance which much be addressed.  Supplements that help reduce insulin resistance include alpha-lipoic acid, berberine, and chromium.
  • checkLower Your Leptin Level – Leptin is another hormone that is usually involved with weight loss resistance.  It also reduces thyroid function by increasing inflammation in the body which impairs the T4 to T3 conversion process.  ​Read more about how to reduce it here.
  • checkStop Extreme Dieting – If you are eating less than 1500 calories per day just to maintain your weight, you are damaging your metabolism and lowering your T3.

​3. Short-acting Liothyronine (Cytomel)

​Cytomel is the brand name for liothyronine, but over the past few years generic versions have become available that are less expensive.  ​

Liothyronine is available in 3 strengths – 5mcg, 25mcg, and 50mcg.  I personally have never prescribed the 50mcg dose.

​Typically, the 5mcg dose is prescribed first, then it may be increased to 10mcg (2 tablets) depending on the patient response and labs.  If more is needed, usually 1/2 pill of 25mcg is given, then possibly a full 25mcg tablet.

– Liothyronine/levothyroxine in Combination

​This is by far the most common way that liothyronine is used.  Fortunately, medical providers are becoming more comfortable using it so its use is expanding.

Liothyronine is added to the patient’s current dose of T4 medication (levothyroxine).

Remember, liothyronine is 3-4 times more potent than levothyroxine, so you will need to be aware of any side effects and your labs will need to be monitored closely.

If your TSH is suppressed excessively, it may be necessary to reduce your dose of levothyroxine.

– Liothyronine only

​Most physicians will not be comfortable prescribing liothyronine by itself.

​This is because most medical committees recommend using a T4 thyroid medication as first-line treatment of thyroid issues.

However, many patients ​with weight loss resistance, leptin resistance, and other hormone imbalances may benefit from using T3 by itself.

T3 medication can be used temporarily to boost the body back into action or it can also be used long-term.

As long as it is used correctly and monitored closely there should not be any long-term consequences in using it.

If you are interested in using it, you must find a doctor with experience in prescribing it, and you must be willing to get regular lab tests and follow-ups with your doctor.

4. Sustained-Release (SR) T3

​Occasionally patients may be extremely sensitive to T3 medication.  In those situations, it may be necessary to have a compounding pharmacy ​make a sustained-release ​form of T3.

The sustained-release formulation will ​allow the T3 to be released ​gradually over a longer period of time which will reduce the side effects that the T3 may cause.

Liothyronine Side Effects

​Some patients tend to be very sensitive to T3 medication.  This usually causes them to feel jittery or anxious when they start the medication.

If you have a history of being sensitive to other medications, you need to let your doctor know before starting T3.  You can probably still take it, but you will need to go “low and slow” with it.

As a general rule, I have found that women tend to be more sensitive to T3 than men, although there are certainly exceptions with both.

The side effects of liothyronine seem to mirror those caused by hyperthyroidism.  These include:

  • checkJitteriness – usually dose-dependent and from taking too much
  • checkPalpitations – usually a sign that the dose is too high
  • checkNausea 
  • checkHair Loss – usually temporary and resolves in 3-6 months
  • checkHeadache – usually an indicator that the dose is too high
  • checkTremor – usually dose-dependent
  • checkSensitivity to Heat – and indicator that the dose is too high
  • checkAnxiety – an indicator that the dose is too high

​If you develop any of these symptoms you should notify your prescribing doctor and discuss treatment options.

Summary

​Liothyronine is a T3 only medication.

It is the most potent thyroid medication available.

When used correctly and closely monitored, liothyronine is extremely effective in treating hypothyroidism and reducing symptoms.  It typically causes some weight loss as well.

It can also be used to treat resistant depression.

​Now it’s your turn…

Have you ever taken liothyronine?  If so, what were the results?

Leave any questions or comments below.

Treatment of Reverse T3 Dominance

Reverse T3 dominance could be the reason why you still have hypothyroid symptoms even though you are taking thyroid medication.

Or why you struggle to lose weight even when your thyroid labs are “normal.”

Never heard of reverse T3 dominance?  Most people haven’t, including most doctors.

High levels of reverse T3 could be slowing down your metabolism, reducing thyroid function at the cellular level, and causing multiple symptoms of hypothyroidism.

The purpose of this article is to inform you about reverse T3 – its purpose in the body, what causes it to get elevated, how to test for it, and how to reduce it back to optimal levels.

Let’s get started…

More…

What is Reverse T3?

The thyroid gland primarily produces T4.  That is thyroglobulin with 4 iodine molecules attached to it.

T4 is the inactive transport form of thyroid hormone.  In order to be used by the body, an enzyme called a deiodinase must cleave off an iodine molecule to convert it to T3.

T3 is the active hormone that can then interact with cells of our body and turn on certain cellular functions.

However, T4 can also be converted into reverse T3.

Reverse T3 will also bind to the cellular thyroid receptors.  However, it doesn’t trigger any cellular reactions.

So basically reverse T3 serves as a “brake” to our thyroid system.

Why Do We Have Reverse T3 in the First Place?

The production of reverse T3 is normally not a bad thing.  It gives our body another way of regulating our energy production and output.

Reverse T3 production will increase during times of extreme stress.

That makes sense if you think about it closely.

For example, if you have an acute infection such as pneumonia, a kidney infection, or you’ve had something like a car accident and have suffered multiple injuries, your body needs to turn down the metabolism to conserve energy so it can be used to fight the infection or injuries.

This system works very well for such acute situations.

There is actually a medical term for this condition – Euthyroid sick syndrome.

However, with the onslaught of chronic conditions and resulting inflammation in our society, it has also become extremely common ​outside of the acute setting of a hospital.

People that are under extreme stress develop this condition which results in a high reverse T3 level, low free T3 level, and a normal TSH and T4 level.

Does this sound familiar?  Do your labs look like that?

In 20+ years of private practice, I have never seen this diagnosis given to a patient that wasn’t in the hospital.

But if you look at studies like this one, ​something as common as a calorie-restricted diet can raise reverse T3 levels and lower free T3 levels and cause other symptoms that “resemble euthyroid sick syndrome.”

So what is going on?​  What causes the reverse T3 levels to increase (reverse T3 dominance)?

Let’s talk about it more…

What Causes Reverse T3 Levels to Increase?

From what we have discussed so far, unless you are acutely ill or have suffered a major injury of some sort, you want your reverse T3 level to be as low as possible.​

​Does an elevated reverse T3 cause any symptoms?

The answer is yes! 

The symptoms will be the same as you would think of with someone with an extremely slow metabolism (which is what reverse T3 dominance causes):

  • Constant weight gain without changing your eating habits
  • Severe fatigue
  • Symptoms of hypothyroidism
  • Depression or anxiety
  • Joint pain

If you have any of these symptoms, it’s important to get your reverse T3 level checked and follow the treatment instructions that I will discuss below.

But first…

What are some of the most common causes of reverse T3 dominance?

    • Chronic physical or emotional stress – This can include job stresses, financial problems, family issues, death of a loved one, and divorce.  It also includes trauma including PTSD or permanent injuries from car wrecks, etc.
    • Chronic illness or infections –  This can include infections such as mono or SIBO, or chronic illness such as cancer, diabetes, heart disease, or even obesity.
    • High or low cortisol (Adrenal fatigue) – Either end of the cortisol spectrum will affect reverse T3 levels.  Read more here.
    • Low ferritin – Suboptimal levels of iron and ferritin have been shown to increase reverse T3 levels.
    • Acute illness or injury – Patients with an acute issue that requires ICU treatment have been shown to have low T3, high reverse T3, and normal TSH levels.
    • Severe calorie restriction – especially HCG diets or very low calorie diets.  These diets have been shown to increase reverse T3, slow metabolism, and make it almost impossible to have permanent weight loss.
    • Chronic inflammationAny inflammation will result in reduced T4 to T3 conversion and an increase in reverse T3 production.  Inflammatory conditions include autoimmune disease, leptin resistance, insulin resistance, intestinal dysbiosis, and cancer.
    • Chronic untreated gut infections or imbalancesUp to 20% of all conversion of T4 to T3 occurs in our gastrointestinal tract.  Any gut imbalance therefore has a huge impact on thyroid function.  Examples of this includes SIBO, GERD, yeast overgrowth, inadequate gut bacteria, overuse of antibiotics, and inflammatory bowel disease.
    • Certain medications – Medications that can increase reverse T3 levels include beta blockers, diabetes medications, anti-seizure medications, depression medications and narcotics.

​If you have one or even more of the above issues, it is important for you to be tested for reverse T3 dominance.

How to Test for Reverse T3 Dominance

Testing for reverse T3 dominance is readily available but may be hard to get ordered.

You will need to see a doctor that has a full understanding of the thyroid and doesn’t just depend on the TSH to determine thyroid health and function.​

It is critical that you get a complete thyroid panel.  I discuss this more in this article.

This will include the TSH, free T4,free T3, reverse T3, TPO antibodies and thyroglobulin antibodies.​

As you can see from this graph, when reverse T3 dominance occurs, the TSH level will remain normal the vast majority of time.  So will the free T4 level, which is the other lab test that most conventional doctors will order.

The lab tests that will show an abnormality the quickest will be the reverse T3 level and the free T3 level.  You can see that as the reverse T3 levels rise, the free T3 levels fall.

Even though your TSH may be normal, your thyroid is not working well at all!​

That is why the reverse T3 and free T3 are absolutely the most important thyroid tests to get when assessing for reverse T3 dominance.​

You will also want to check the ratio of reverse T3 to free T3 to get an idea of what is happening in your cells.

Normally you want your free T3 to be as high as possible and your reverse T3 to be as low as possible.

I consider a reverse T3 > 15 to be abnormal.

It is possible to have a normal free T3 level but still have a very high reverse T3.  That is why the ratio is important.

​To get the ratio, divide your free T3 by your reverse T3.  The ratio should be >0.20.

Any number less than 0.20 indicates that you have too much reverse T3 and you need to take steps to lower it.

How to Lower Reverse T3 Levels

Okay, so you’ve gotten the necessary lab tests, and your reverse T3 level is > 15 and/or your free T3: reverse T3 ratio is < 0.20.

What can you do to decrease your reverse T3 dominance?

The single most important thing is to identify the root cause.​  This is always the primary goal of functional medicine.

If your diabetes is out of control and you don’t change your diet and lifestyle, your reverse T3 will not decrease.

If you are in a toxic job or a toxic relationship, you will never get your cortisol levels in the optimal range which will prevent your reverse T3 level from dropping.

I could give several other hypothetical situations, but I think you get my point.

Focus primarily on the issues that you know you have FIRST.  Then consider some of the other treatment options I will discuss below.

1. T3 Medication

The quickest way to reduce reverse T3 levels is by using pure T3 hormone.

This includes short acting T3 such as Cytomel or liothyronine, but also sustained release T3 from compounding pharmacies.

This is so effective because you are able to skip the conversion step required with medications that contain T4 such as Synthroid and levothyroxine.

Your body can’t make reverse T3 unless it has T4.  If you remove the T4, the reverse T3 levels will obviously drop.​

Make sense?

When you give T3 only medication, it will result in the free T3 level rising, T4 level dropping, reverse T3 level dropping, and the TSH level dropping.​

When on this therapy, it is very important to monitor your reverse T3 levels closely, usually every 1-2 months.

Typically the reverse T3 level will drop below 10 within 2 months (assuming you are on enough T3).​

This is by far the fastest way of reducing your reverse T3 dominance, but if you don’t identify and correct the root cause, it will just go back up.​

By the way, natural dessicated thyroid (NDT) medications such as Armour Thyroid, Nature-throid, and others may not be adequate to lower reverse T3 levels.​

They are still about 80% T4, which may still provide too much T4 that can be converted to reverse T3.

If you are on an NDT medication, you may need to reduce the dose for a couple of months and add T3 to lower the reverse T3 levels.​

Again, it will be imperative to identify the root cause of your reverse T3 dominance, or else the reverse T3 levels will go back up once you return to your typical NDT dose.​

2. Increase T4 to T3 Conversion

Every patient with a thyroid issue is going to need one or more supplements.​

Why?​

When you have low thyroid you produce less stomach acid which results in less nutrient absorption.

I discuss many nutrient deficiencies and supplements here, but for this article I will only mention those that help with conversion of T4 to T3.​

​The primary nutrients that have been shown to increase this conversion are zinc and selenium.  Increasing conversion of T4 to T3 means less conversion to reverse T3 which will lower its level.

My preferred supplements are below:

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

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

3. Manage Leptin Resistance and Insulin Resistance

​Most hormones in the body work together.

When there is a change in one hormone, it will affect other hormones as well.

In fact, hypothyroidism has been linked with leptin resistance as well as insulin resistance.

Hypothyroidism leads to a state where it is easy to develop leptin resistance and insulin resistance.

Conversely, leptin and insulin resistance slow metabolism and increase inflammation which increase reverse T3 production, which makes losing weight almost impossible.

Very high reverse T3 levels are almost always found with elevated insulin and leptin levels.

That’s why you need to request a fasting insulin and leptin level if your reverse T3 is > 15.

You will not be able to get your reverse T3 level down and keep it down if you don’t also address the leptin and insulin resistance.

You can read more about how to do that in my article here.

4. Decrease Inflammation

​Inflammation is a vague concept.

We all know that excessive or prolonged inflammation is bad, but what do we do about it?

It is hard to measure and even harder to treat.

However, it’s important to identify and address because inflammation directly increases conversion of T4 to reverse T3.

The lab tests that we use to measure inflammation in the body are nonspecific, meaning they do not tell us what is causing the inflammation.

If they are elevated, it can still indicate to us that inflammation is high in the body and we need to identify the source of it.

The primary tests that indicate inflammation are:

    • C-reactive Protein (CRP) – Should be as low as possible (<1.0)
    • Erythrocyte Sedimentation Rate (ESR) – Best if this is < 10.

​If you have high levels of inflammation AND high levels of reverse T3, you can safely assume that inflammation if causing or at least worsening your reverse T3 dominance.

The next step is to identify the source of the inflammation.

In hypothyroid patients, the source of inflammation is usually from one of 3 issues:

    • Food Sensitivities -typically gluten and dairy but there may be others.  They promote inflammation, primarily in the gut.
    • Gut imbalances – such as SIBO or yeast overgrowth.  Both also increase inflammation.
    • Hormone imbalances – especially insulin resistance and leptin resistance.

If your CRP or ESR levels are elevated, you should look closely at these 3 common sources and address them.

If you don’t know the source of your inflammation, you can still consider some supplements that help reduce inflammation by improving the detoxification of the body, primarily in the liver:

Just blindly treating inflammation is far from ideal but can be helpful if you can’t identify the source of your inflammation.

5. Lifestyle Changes

​Without getting overly technical, doing 4 basic things can make a huge impact on your health, including your reverse T3 levels:

    • 8 hours of quality sleep per night
    • Reducing and managing your stress
    • Eat a balanced diet of whole, real foods
    • Daily low intensity exercise and episodes of high intensity exercise 1-3 times per week

Just doing these 4 things alone will do more to bring you back to a state of health than anything else we have discussed.

On the other hand, if you do everything else that I recommend in this article but neglect these 4 things, you will not be successful and your reverse T3 dominance will continue.​

I realize these things are easier said than done, but they have to be a primary focus for you to have success.​

​By the way, reverse T3 is an important component of our thyroid hormone system.

Decreasing reverse T3 levels are not harmful in the short term and can in fact be helpful.

However, persistently low levels of reverse T3 increases the risk for hyperthyroidism if left suppressed for a long time.

That’s why the goal will be to “flush” out the elevated reverse T3 levels for only a short period of time and then allow the body to balance out the levels of T3 and reverse T3.

Summary

Reverse T3 dominance is a common problem for many hypothyroid patients. 

It may be the primary reason why some patients have persistent hypothyroid symptoms despite being on thyroid medication and why so many thyroid patients have difficulty losing weight and keeping it off.

In order to diagnose reverse T3 dominance, you need to have your free T3 and reverse T3 levels checked.

A reverse T3 level > 15 is considered abnormal, and a T3:reverse T3 ratio of < 0.20 indicates that you have too much reverse T3.

Treatment includes taking T3 medication for a short period of time, taking supplements to improve T4 to T3 conversion, and making appropriate lifestyle interventions to reduce stress, inflammation, and leptin/insulin resistance.

Doing all of these things can help get your body back and balance and reduce your hypothyroid symptoms and weight loss resistance.

Now it’s your turn:

Do you have reverse T3 dominance?

What treatments have you tried?

What has worked for you?

Leave your comments below.

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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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