Oops! I forgot to take my medication. Plus, how’s your poop? Episode 17.

ITunes Review: 

Stephanie, Thank you so much for a wonderful podcast. I love that you keep it real while answering difficult questions for us. You have a very calming and peaceful voice and I am always so encouraged listening to your podcasts. Keep them coming. We are listening and learning. 

What do you do if you forget to take your medication? 

Half life- a half life in the world of medications means the amount of time it takes for the concentration of the medication in your blood plasma to reduce by half.  Said another way- it is how long a drug stays in your system or the amount of time it takes for the effectiveness of a drug to reduce by half. 

If you are taking levothyroxine, the half life is 6-7 days and up to 9 or 10 days if you are dealing with hypothyroid conditions. If you have hyperthyroid conditions then it can be as little as three days. Nothing seems to be easy with this disease. 

Levothyroixine is a common treatment and most likely what your doctor will prescribe unless you have a doctor open or more knowledgeable in thyroid health. 

For practical purposes we will go with a 7 day half life for levothyroxine. When you take this medication, around 80% of it goes through your system over a longer period of time, like several hours. 

According to the Williams Textbook of Endocrinology, missing a day shouldn’t have a big effect on you. They also say that T4 is absorbed very well by the body so waiting an hour to take your medication before eating might not necessarily be required. Taking it on an empty stomach will give you a more stable TSH reading though. But since we all know that TSH should not be the gold standard, that maybe shouldn’t matter. 

The reason you usually have to wait 6 weeks to have your labs tested is because of this long half life. It takes about 6 weeks before your body has adjusted to a dose. 

However, if your digestion is not working well and we are going to talk about that in a minute, then you may have issues with absorption and of creation of T3 from your T4 only medication. 

There can be an issue in concentration of medication between manufacturers which can mess with your body. So, be proactive and let your pharmacy know that you do not want them to switch your medication without your knowledge. Remember that getting this dose right is like goldilocks- it needs to be just right. 

This same textbook also says that NDT is not a good choice for treatment and that TSH is the gold standard so- take it for what it is worth. 

A NDT like Armour has a half life of 2-7 days with the T3 having a half life of 4-6 hours. So if you take your medication with T3 in it at 8am then sometime between 12pm and 2pm you have about half of the original dose of medication in your system. Your cells will have used the rest of it. But it should last you about a day. This means half is gone in 4-6 hours, another half of the half (a quarter more ) will be used in another 4-6 hours and so on. 

T3 is used up faster because your body doesn’t have to convert it like it does T4. This is why it is a good idea to take a partial dose in the morning and a partial dose in the afternoon. 

Now let’s talk about what happens when our digestion isn’t working well because this is very important for our thyroid to work well. 

Thyroid peroxidase is an enzyme. It makes thyroid hormones by cleaving off an iodine molecule and adding it to the amino acid tyrosine on thyroglobulin which then makes T4 and T3. In order for this to happen, we need to have available to us: selenium, copper, magnesium, B vitamins, zinc, vitamin A. 

You should not just go and willy nilly supplement with these vitamins and minerals. There are many factors involved here and supplementing with some of these may make things worse in the long run. So it is a good idea to either do a lot of your own research or work with someone who knows how to work with your condition. 

Our gut or gastro intestinal tract is an important factor in our thyroid health but even before that, what we eat and how we break it down in our stomach is a key factor. 

Before we even talk about what you are eating, let’s talk about how you are eating it. Are you running through the drive through before or after your kids activities? Are you eating in the car or eating while you are doing something else?  Are you relaxed or stressed while you are eating?

Any of those scenarios will mean you are going to struggle with breaking down your meal before it even gets to your small intestine where most of the nutrients are absorbed. 

Digestion actually starts in the brain. We smell our food cooking and our brain signals the production of saliva so we can break down some of that food in our mouth while chewing. Are you chewing your food well? Like 20-30 chews per bite? Really breaking it down so the enzymes in your saliva can begin digesting the carbohydrates in your meal?

Once you have chewed well, you swallow and that ball of food goes in to your stomach and stomach acid and pepsin get to work digesting or breaking down proteins. 

Do you have acid reflux after eating? (there is more about this in the audio)

Once it is broken down in the stomach and reaches the right pH then the valve between your stomach and your small intestine opens and fats are broken down by the release of bile and nutrients are extracted in the small intestine and absorbed in to the blood stream. 

Here is where your gut health comes in to play since leaky gut or Intestinal Permeability are what contributes to autoimmunity. 

We need a balance of gut bacteria in our intestines to help us convert T4 to T3 there. If we are not eating right or digesting well then we will have an imbalance of bacteria and intestinal permeability. 

We can end up with parasites, overgrowth of candida and constipation- all with their own contributions to our failing health. 

When we have hypothyroid- we have a sluggish gallbladder which means we might struggle to digest our dietary fats and then we are making thick and viscous bile which further messes up the gallbladder function. When this is not working well, we are not detoxifying as well either. so we can’t break down hormones or toxins from our environment. 

How are you pooping? No one wants to talk about it but you must be moving stool through your body and going every 16-24 hours. Your BM should be the size of your forearm from your wrist to your elbow, it should come out with ease and you should feel relieved when you are done and not like you still have to go. 

Being constipated further contributes to the “bad guys” overgrowing in your Small Intestine and causing bacterial infections, you may experience chronic pain, inflammation, digestive issues, food intolerances and Hashimoto’s. 

With all of this happening, we can also have issues dumping estrogen and so it can accumulate. This can cause hypothyroidism that you won’t see on a blood test according to Datis Kharrazian in Why Do I Still Have Thyroid Symptoms. This excess estrogen will keep the thyroid hormones from getting to the cells- causing hypothyroid symptoms. 

So you see, taking supplements without first healing the gut is pointless. It is a band aid at best. The only supplement you may need at this point is some stomach acid- Betaine HCl so you can start to break down your food and get those nutrients to your cells, kill off some of the bad guys and bring things back in balance. 

You will see improvement in chronic inflammation from changing what you eat and the way you eat it. Start with your plate. With breakfast. Make some bone broth. That is the next recipe to go out in my newsletter so sign up for that. 

So reduce inflammation by cutting out gluten, dairy products, eggs, most other grains, soy products and yeast. Yeast can feed an already out of control candida overgrowth. These are some of the big allergens, in other grains it is best to avoid corn for sure. 

This gives your body a chance to calm down so it can properly react to foods. 

You need to be on an elimination diet for 3 weeks to 3 months depending on how sick you are, how inflamed, or how long you went untreated for Hashimoto’s. In addition to this, you can do something called a FIT test

What can you eat?  There are no notes for this. It’s only on the audio. 

Why Do I Still Have Thyroid Symptoms?

Against All Grain

Meals Made Simple

High T3, low T4, recommendations on supplements to feel better. Episode 10.

Welcome to episode 10. I hope this day finds you well and that everyday in every way you are getting better and better. 

Let’s get started. I got a question from Jordan. 

Hello Stephanie,     

    I'm very intrigued by your podcasts and enjoyed the free EBook! I was diagnosed with hashimotos auto-immune 2 years ago I've been on levothyroxine and my t3 remains high my T4 remains low but my tsh is always within normal ranges! My hair is terribly dry, brittle and gray and at the ripe age of 30 I'm heading to being bald! My bowels are Terrible to the point I was believing I had Celiac's or a gluten or wheat allergy until I listen to the podcast! I'm extremely overweight and I'm working hard on that as I'm 60lbs down! I have several of the symptoms of the adrenal fatigue except once I fall asleep I stay asleep and want to sleep hours upon hours! I'm writing to you to see if you could recommend to me some vitamins or suggestions so I can feel better. I'm a single mother on a extremely tight budget!  Thank you for your time! 

        Jordan

In the early stages of hashimoto’s people can have symptoms of both hypothyroidsim and hyperthyroidism. You can have palpitations, tremors, be really thin and have anxiety. You can have the dry brittle hair that is falling out and you can feel like you are going crazy. 

In hashimoto’s, your immune system is attacking the thyroid gland causing bits of thyroid hormone to be released in to the blood stream making you feel like you are experiencing hyperthyroidism. 

So what is happening? What will the issues be that you may have?

• food sensitivities

• nutrient deficiencies

• adrenal fatigue

• possibly an infection in your gut

• poor detoxification- you are not able to clear out toxins

Any or all of these will keep your immune system on high alert and continue the attack on your thyroid. 

The high T3 is probably what is causing your hair to fall out. This can be indicative of high antibodies and since you have a diagnosis of hashimoto’s this could be what is going on here. You can ask to have your thyroglobulin antibodies along with the thyroid peroxidase antibodies tested. This should confirm why T3 is high. 

Low t4 can indicate disease in the thyroid or a problem with the pituitary gland or the signal that tells your thyroid to make more thyroid hormone. Your TSH is in the normal range, you said- I assume that is conventional range. If it is above three, functional medicine would consider that high. So, The pituitary gland would release TSH if t4 is low and a high TSH level would probably mean the thyroid itself isn’t working well and you would have hypothyroidism.  If t4 is low and TSH is not high then the pituitary gland is not signaling correctly. This is something you would want to discuss with your doctor. 

You also need to take a look at all of these things to bring down the inflammation and hopefully put your hashimoto’s in to remission. 

You may have deficiencies in the micro minerals like selenium, zinc, vitamin D, iron, B12 and B vitamins in general. First and foremost though you need to see if you have low stomach acid.     

Let’s start with Selenium: 

Many of us with hashimoto’s are deficient in this micro mineral which can be one of the things that causes us to get hashimoto’s. It helps to break down and make neutral the free radicals made during thyroid hormone production. If we are low on selenium, damage to the thyroid can occur and our ability to convert T4 to the T3 (which is what our cells take in) is affected. Take around 200 micrograms of this one. It has been shown to help reduce thyroid antibodies. 

Vitamin D:  

This helps to regulate our immune system and remember that hashimoto’s is an immune system problem first and foremost.  Your levels should be around 60-80 when you have it tested for optimal immune system regulation. 

D3 is the more absorbable form and you should make sure that it is in a capsule or liquid form with some kind of high quality fat like olive oil or MCT oil (a broken down portion of coconut oil). It is a fat soluble vitamin so you need to take it with fat for your body to use it. 

Good food sources for vitamin D are cod liver oil, fish, eggs and sunlight

B12-

If you have major fatigue, you should have your levels of B12 tested. It plays a role in digestion too so you want to make sure you are, again, making enough stomach acid. Most of us with hashimoto’s and hypothyroidism have low stomach acid. 

When you have low stomach acid, you don’t digest your food well which means your body has to work harder to break it down which requires energy. 

One of the possible causes for the low stomach acid is a B12 deficiency. And a B12 deficiency can cause low stomach acid. Vicious cycle. If you don’t have enough stomach acid you can’t get the nutrients including B12 and iron out of your food. You won’t be breaking down your meals as well and this can lead to food sensitivities. 

Betaine HCl with Pepsin. This is stomach acid in capsule or pill form. I recommend starting out with around 150mg pill to see where you are at. It will help you digest and break down your food better so you can use the nutrients in your food. 

Next, Probiotics. 

Intestinal permeability plays a pretty big role in autoimmune disease. One of the things linked to it is having your gut bacteria out of balance. Having more “bad guys” than “good guys” can cause gut issues and anxiety. You have about 100 trillion bacteria in your gut. 

Start with a 10 billion CFU per capsule and increase every couple of days until you see or feel die off symptoms. The die off is the bad guys dying out and the good guys taking over. The bad bacteria will release toxins that might make you feel bad for a couple of days. This can also exacerbate the inflammation and immune response so make sure  you have good eliminations and are drinking plenty of water. 

One of the best ways to get a lot of good bacteria in to your digestive tract is by consuming fermented foods like sauerkraut- not canned sauerkraut but the raw fermented kind found in the refrigerator sections of stores or find it at farmers markets. Or make it yourself. It is so easy to do and really inexpensive. 

Here is a good explanation of what leaky gut or intestinal permeability is and how it affects the immune system from Sean Croxton: 

“think of a window screen. And I say, “It’s a hot day. You open up the windows. And the good air comes through to cool the place off. And it feels nice and good and what not. But it keeps all the bugs, the flies, the gnats and the mosquitos out of the house. And that’s how the gut works. It’s very selective about what it allows through into the bloodstream or wherever.

“But if some kid came over to your house and started poking big holes in your window screen, then what happens is you open up the window. And gnats might come in. Flies might come in. What do you do? You start grabbing a magazine and like whacking away and stuff. And that’s what your immune system does, right? It says, “Wait. This isn’t supposed to be here. So let’s start whacking away.” And now we’ve got a problem. We’ve got an overactive immune system.”

Glutamine- 

This will help heal your small intestine where intestinal permeability happens. It helps to repair the lining of your small intestine where new cells are made every 3 or so days. 

Zinc can also be helpful in repairing leaky gut and in helping you make enough stomach acid. 

If you are dealing with any kind of adrenal fatigue: 

This would mean your brain is not communicating with the pituitary gland to help your adrenals manage stress. This is called the HPA axis and it also helps to regulate the immune system. When we are stressed, this system doesn’t work well. 

If you are dealing with adrenal fatigue you may feel: 

• overwhelmed

• tired even with 8 hours of sleep

• like staying in bed in the morning

• a craving for salty foods

• daily things are too much to handle

• brain fog

• little to no sex drive

• like you can’t make a decision

Adaptogenic herbs like American Ginseng, ashwagandha, Asian ginseng, Cordyceps and Chaga mushrooms, and/or holy basil and licorice root may be helpful. 

You should work with a practitioner to find out if you are in need of supplementation here. 

Some things that can help you manage your hashimoto’s is your diet. 

• Being gluten free, dairy free or try an elimination diet to help you figure out which foods you are sensitive to. This will also naturally help you balance your blood sugar which will also help give your adrenal glands a break.

• Make sure you are eating protein of some kind at every meal, including breakfast and eat breakfast within an hour of getting up. Don’t skip any meals and don’t do any fasting.

• Eat 4-5 meals per day for a week or so to give your blood sugar regulation system a break.

• Have a snack of protein and fat or a starch before bed. Make sure any carbs you are eating are eaten with protein.

• Avoid caffeine

A word of caution on supplements. Please don’t go buy them at your local big box store or the corner pharmacy store. Don’t buy them on Amazon either. I suggest at the very least to buy from Vitamin Shoppe or from your local food coop or even Whole Foods. You should work with a practitioner that can help you find just what you need though

The reason for this is there is no regulation on supplements. They don’t have rules in manufacturing or labeling. Some supplements won’ t even have the ingredients stated on their label or the dose can be way off. Some might have gluten or dairy in them and you might have a sensitivity to it. This is one case where quality really matters. 

A practitioner should be able to find what is most bioavailable for you since there are multiple chemical formulations of certain nutrients and some work better than others. Some are more expensive than others to manufacture. 

You also need to make sure you start with low doses so as not to over do it.  You just don’t know how your body will react to a new supplement. Starting slowly with lower doses will help you catch a reaction to it before it gets too bad. 

There is no magic supplement that will fix the hashimoto’s or anything for that matter. Some of these will definitely help you on your journey to healing or remission or whatever you want to call it. 

My top picks would be Hydrozyme from Biotics which is a lower dose stomach acid supplement and diet changes first and foremost. You can get that by going to www.getbiotics.com and using my practitioner code DFILC163. 

When starting a dose of stomach acid, remember to take a few bites of your protein based meal, take a pill, take a bite of food, take a pill and you do this until you feel a little burning sensation. Then you know to take one less than what gave you the burning sensation. 

Thanks so much for listening. Please tell anyone you know who has been diagnosed with Hashimoto’s to listen in and if you would be so kind as to leave a review on iTunes so more people can find this podcast that would be great too. My goal is to help as many people as possible to feel better and beat this disease. 

Got a question about your thyroid or hashimoto’s? Please send your questions to helpforhashimotos@gmail.com or head on over to my website and fill out the contact form there. 

You can find me at www.outofthewoodsnutrition.com or www.helpforhashimotos.com  I’m on Instagram at @Stephanieewalsntp which is where I post the most and on facebook at Out of The Woods Nutrition

See you next time. 

Acid blockers, digestion, and elimination. Episode 8.

Terrible heart burn !!What helps? Has anybody had any issues with Omeprazole or any acid reducer.

OMEPRAZOLE: aka Losec, Prilosec, Prilosec OTC and Zegerid

classified therapeutically as antiulcer agent and pharmacologically as a proton-pump inhibitor

Used for maintenance of healing in erosive esophagitis, duodenal ulcers with or without H.Pylori. Short term treatment of active benign gastric ulcer. The OTC or over the counter is for heart burn occurring more than or equal to 2x a week. 

What does it do?  it binds to an enzyme on gastric parietal cells in the presence of stomach acid. It diminishes the accumulation of acid in the gastric lumen with lessened gastroesophageal reflux and helps heal duodenal ulcers. 

Binds 95% of protein and is metabolized by the liver with a half life of 30 min to an hour. Half life means how long it takes for half of a medication to be eliminated from the blood stream.  

It says to use cautiously in liver disease, in geriatric patients due to increased risk of hip fractures in patients on high doses for longer than one year and in pregnancy, lactation or children. 

Acid blockers like the ones mentioned and also things like mylanta, maalox, tums alka-seltzer, tagamet, pepcid, zantac etc all will lessen the amount of stomach acid you have in your stomach. So how will you break down your food? That is what it is there for.  The acid blockers change the pH of your stomach which is supposed to be very acidic at around 3 I think. This low pH is how we break down our food, especially protein. Protein gets broken down in to amino acids which become neurotransmitter. Stomach acid breaks down our food so we can extract the nutrients we need from it. 

Low stomach acid, which happens naturally as we age and most of us with hypothyroidism don’t make enough of it can lead to anemia, candida, fatigue, constipation/diarrhea, tooth decay, hair loss, and a higher risk of developing food sensitivities. 

So you have less acid when you take an acid blocker but you also have a deficiency of good bacteria, calcium, coq10, folate, glutathione, iron, magnesium, melatonin, niacin, potassium, B vitamins, selenium, vitamin A, C, D and zinc. 

Hypothyroidism can lead to hypochlorhydria or too little stomach acid. This is what often causes acid reflux. When food is not digested well by the acid in your stomach it will putrefy, ferment and become rancid in the stomach. Our small intestine doesn’t like to let undigested or poorly digested food from the stomach enter there so it backs up in to the esophagus, irritating the tissue there and causing heart burn. 

Coffee and nicotine reduce the pressure on the esophageal sphincter so you end up with more reflux.

The food is not as acidic as it should be it doesn’t stimulate the gallbladder to secrete bile to emulsify fat and the pancreas doesn’t get signaled to release digestive enzymes to further digest the food. So you have this rotting food moving through the intestines which will eventually cause inflammation, maybe even an infection and likely leaky gut or intestinal permeability. 

The fat in the food isn’t being broken down by bile from the gallbladder so your cells are not getting any minerals. Zinc is a mineral which helps us produce enough stomach acid. Having hypothyroidism messes with our gallbladder function and it can cause it to become sluggish and it won’t release enough bile. Combine that with the SAD and you have the perfect storm for gallbladder attacks.  When the gallbladder isn’t working well, the liver also becomes sluggish and backed up so it can’t detoxify our hormones, toxins or other things. 

So as you can see, having less than good digestion is a real big problem for those of us with sluggish thyroids. Along with zinc, we end up depleted in tyrosine, selenium and vitamin A and D. When it is not working well it plays a role in autoimmune disease as well. Perfect. Look at all we have going for us!  We have a large amount of our immune system in our gut- around 60-80%. If our digestive tract is out of wack, inflamed, or if we are dealing with parasites then our adrenal glands will end up depleted. This will make your thyroid sluggish as well. 

It just keeps getting better for us. 

Ideal elimination from the time you eat a meal to the time it leaves you in the form of a bowel movement is between 16-24 hours. This is slower with hypothyroidism.  Constipation is anything longer than what your normal elimination would be. You can end up with malabsorption issues and toxins  and hormones get recycled which add fuel to the fire. There is a good chance you will be growing more of the harmful bacteria putting your good guys at risk for being taken over by the bad guys. Remember that we convert some T4 to T3 in the gut but we won’t do that as well when there is an imbalance of bad to good bacteria. 20% of thyroid function relies on the right balance of bacteria. 

Another biggie mentioned briefly earlier is the elimination of hormones, particularly estrogen. I am not a hormone expert but I do know that poor digestion means you can end up with higher amounts of estrogen that can lead to hypothyroidism that doesn’t show up on a blood test. This information came from Why Do I Still Have Thyroid Symptoms from Datis Kharrazian. He says that “excess estrogen binds the thyroid transport proteins so that thyroid hormones cannot get to the cells to do their jobs, causing hypothyroidism symptoms”

There are a lot of things you can do to eliminate acid reflux and keep things moving along smoothly. 

Food sensitivities or allergies can cause reflux or silent reflux which often has a cough with it. 

Look at your diet. As per usual, gluten free, dairy free and an elimination diet are the first place to start.  Remove also, eggs, corn, soy and yeast. This will give your immune system a break. A chance to calm down and your gut can repair itself.  These foods should be eliminated for 3-4 weeks. The longer the better.  Typical food reactions can look like skin rashes, eczema, acne, fatigue, joint pain, bloating, gas, heartburn, constipation, diarrhea and even nasal congestion. You can have anxiety, irritability, headaches and more. 

Manage your blood sugar. 

Stress. Don’t eat when you are stressed, take a minute to calm down, sit at the table without a phone, book or anything else. Take a few deep breaths, say grace if you like or whatever. Then take a bite of your food and chew it really well. Like 20-30 times per bite. 

Don’t drink a lot of water and avoid anything bubbly with dinner. The phosphorus in pop can put you in to sympathetic or fight or flight which will automatically turn off stomach acid production. 

You can take digestive bitters about 20 minutes before dinner and if that is not enough you may need to supplement with stomach acid. Something called Betaine HCl. I like a product called Hydrozyme from Biotics Research. I recommend buying it from a practitioner, not off of Amazon. 

To find out how much you need you take a bite of food, chew it well, swallow it and then take an HCl supplement with a small amount of water. Take another bite of food, chew it well and take another pill. Keep doing this until you feel a little burn, kind of like heartburn or like you just took a shot of alcohol. If you felt the burn at 3 pills then you know you only need 2 at each meal. Eventually you can get enough healing of your body done that you will start to make more stomach acid and you won’t need to take as much of the supplement. 

You can check in on your digestion by keeping a food journal. Write down everything you eat and drink and how you feel afterward. Keep track of your bowel movements. Look at them. Do you see undigested food in your stools?  What shape are they?  You can google the Bristol Stool Chart and see where you are at and where you need to be. Your eliminations should be solid, about the length of your forearm from your elbow to your wrist. It should come out with no straining, you should not feel like your elimination wasn’t complete and you should not have much on the toilet paper after you wipe. 

If you want to test your transit time you can take some activated charcoal pills, like 5 of them or you can eat about a cup of beets, or take 2 tablespoons of sesame seeds. Take them first thing in the morning, don’t chew the seeds if you use them, just swallow them. You want to be able to see them when they come out.  Write down what time you take them and what day you take them. Then keep track of your bowel movements. Write down the first time you see the seeds, beets or charcoal (your stool will be black with charcoal and reddish with beets) and write down the last time you saw them in your stool. The difference between the time you swallowed them and the last time you saw them is your transit time. Remember we are looking for anywhere from 16-24 hours.  Also, ideally you might go two times a day. 

That is it for me today. If you have any questions about this episode or you would like to submit a question for the podcast, please feel free to leave a comment on my website, www.outofthewoodsnutrition.com or www.helpforhashimotos.com or email me at helpforhashimotos@gmail.com

You can find me on facebook at www.facebook.com/outofthewoodsnutrition or on instagram at stephanieewalsntp. 

Thanks so much for listening. I really appreciate it. If you enjoy listening to this and want others to have access to it, I would appreciate it if you left a review on iTunes for me. My goal is to help as many people with thyroid problems and Hashimoto’s or other autoimmune diseases and I can’t do that without your help. Please help spread the word.

The first step to getting your life back is believing that you can!

Thanks again. See you next time. 

Will going gluten free help Hashimoto’s? Episode 2.

In this second episode, we talk about how our immune system is affected by gluten and why it is important to avoid it to ensure our thyroid can stay healthy. We discuss how to go gluten free, how I went gluten free and where to find hidden sources of gluten. 

.

I have Hashimotos and I’m hypo. 

I’m tired of feeling bad everyday. I wake up and go to bed feeling bad. I have no energy throughout the day and I have 3 children to take care of. I’m unable to work due to my anxiety and depression. I have no support at home. 

I haven’t my house in 3 days. I feed my children whatever is quick and something I don’t have to stand over the stove and cook. I’m tired of being this way. I’m tired of being tired. It feels like I don’t belong here. I need help—-

LITTLE BY LITTLE, A LITTLE BECOMES A LOT.  I have been there. When I was first diagnosed I had a 2 year old and a baby. I remember my tongue feeling heavy and it felt really hard to talk. I remember writing a check and feeling like it was so much effort to move the pen across the paper. 

My first best guess is that you are either not on the right dose of medication or you are not able to convert the T4 in your medication to the form your cells need which is free t3. 

If you can, search for a doctor willing to test more than TSH which is a test looking at what your brain is telling your thyroid to do. Thyroid Stimulating Hormone is coming from the pituitary gland. When the amount of thyroid hormone in your blood is low, it is stimulated to send a message to the thyroid to make more hormone. When there is too much thyroid hormone in the blood it is stimulated to tell the thyroid to make less. So when you have a high TSH (mine was 150 when I was first diagnosed and then the doctor was happy with it around 5 despite the fact that I still felt terrible) it means you are in a hypothyroid state or your thyroid has been told to slow down. When your TSH is really low that means you are in a hyperthyroid state and your thyroid has been told to speed up. The reason why your number is what it is, is dependent upon your bioindividuality. TSH can vary from day to day as well so when you go in, you are getting a picture of how things are working at that moment. This is true of many blood tests.  The other problem here is the way the lab ranges were made. The “normal” range was set based on a group of healthy and sick patients. Some with thyroid conditions, and some without so the range is not necessarily based on healthy people. Most healthy folks have a range at or around 2.5. Personally, I am feeling much better at just below one. I am on compounded medication though and so that makes the TSH test result lower than normal. The problem is your doctor may have a lab range that shows 8 as normal which for most people will make you feel sluggish, tired when you wake up or need to sleep 10-12 hours or more, gain weight, lose hair, feel cold and generally not feel well. This is why it is so important to find a practitioner who will treat you based on your symptoms and not just on your labs. Take note that a normal or low TSH number doesn’t mean you don’t have low thyroid function. 

Free T3 and Free T4 measure the levels of the active hormone in your body. Free T3 is a more accurate indication that your thyroid is working properly. The free in these means they are available for your body to use. 

Depression is really common in people who are on T4 only medications. If that is the case for you, switching to a Natural Desiccated Thyroid Hormone Medication could help you out a lot. Before you even do that though, you really should take a look at your diet. If you body is not nourished it can’t do what it needs to do because certain biochemical processes in the body need certain nutrients to do their job. For example, the enzyme that makes T3 free for the cells to take up is very sensitive to things like malnutrition, inflammation and toxicity in the body and will not work as well. 

The major nutrients needed to make our thyroid work well are: iron, B12, vitamin A, vitamin D, magnesium, selenium, zinc and iodine. 

TPO Antibodies (Thyroid peroxidase)- this is an enzyme that is needed to produce thyroid hormone. 

TG Antibodies (antithyroglobulin)- this is a protein carrier for your thyroid hormone. 

These two mean your immune system has produced antibodies to attack because they perceive a problem. When these are present, it can make using the other labs useless because an unmanaged autoimmune condition can cause you to swing between hyper and hypo. 

What are your symptoms?

What I am seeing here for your symptoms are no energy, basically tired all the time, and anxiety and depression. You also state you have no support at home. I’m sorry. That makes it especially hard and I get how you feel. I didn’t have a lot of support in the beginning either. I suffered for years and my family suffered because I suffered. My kids, between toddler and early teenage years had a mom who had zero energy. who was angry all the time, who didn’t sleep at night and therefore was totally crabby. Everyone felt like they had to walk on eggshells around me and I have a lot of guilt over that. It took changing my diet without support for me to really see a change in my mood and my energy. Figuring out which foods were sucking the life out of me helped a lot. 

So, diet first. You can manage the autoimmune portion of the thyroid (the hashimoto’s) with nutrition. Start with gluten free, then dairy free and then you would want to consider an autoimmune protocol diet/elimination diet. You probably will find that the changes in diet will be life changing for you. 

You may need to take some supplements as well. Get your vitamin D checked to see if it is low and if you supplement with it, monitor your levels to make sure you don’t over do it. 

A lot of us will have iron deficiency as well. Get a full iron panel, especially ferritin. You need a ferritin level of around 75 for T4 to convert to T3. If you have a ton of inflammation you might have high levels of ferritin so as you change your diet, and reduce inflammation in the body, you should have this checked as well. 

Almost all of us are magnesium deficient. It does a lot of stuff in the body. 

We need selenium for enzyme systems in the body that help the thyroid work well. Chelated selenium is recommended at a dose of 100-200mcg a day. 

Zinc- important for us to make enough HCl to digest our food but also important in T4 to T3 conversion as well. 

It is also very important to manage your blood sugar. This can be done with diet and I often find people need support to do this but if you can do it on your own, great. 

You may need fish oil and a B complex as well but I recommend working with someone to figure out just what your body needs. 

Best of luck to you on your journey. 

NEXT Q

Hi. My insomnia, fatigue, and short term memory problems have been really bad lately. I don't know what to do. My newest endo wants me to chase down a whole bunch of other possible reasons for my symptoms. I suppose there's always a possibility that I've developed another autoimmune disease that causes the same symptoms. But, I'm exhausted. I feel like I'm being sent down a rabbit trail that I'll never get off of. I need something that works. Tell me honestly, how much better did those symptoms in particular improve with diet and exercise? I hate always feeling this way.

Does anyone ever have issues controlling the temperature of your body? Like being too hot or too cold? Is this part of Hashi’s?

I was diagnosed with hashimotos after my daughter was born a little less than 3 years ago. My whole life I was a size 5 and now I’m a size 14 and can’t seem to lose weight. My levels seem to like to jump around a bit but currently are level.

What I want to know is what do you do about the lack of energy? I have no energy. I don’t even know where to start with diets or what to do. What are diets that have helped? Anything!!! My energy is so low that I can barely get up some days.  Also all I have currently is a family doctor. Should I be trying to get connected with another kind?

1. Diet- yes diet helps. AIP, Paleo, gf/df, sugar free, managing blood sugar. Find a practitioner to help you.

2. Diet will help with weight and energy

3. Temperature issues can be related to the kind of medication you are on. Natural Desiccated Thyroid hormone can help with this. Either way you are probably not on the right dose of medication and/or it can be that your have low iron. Eating meat and liver especially is a great way to get liver from diet. Low iron is a big deal for us. I said earlier that ferritin is super important here but a full iron panel is very helpful. TIBC or total iron binding capacity is measuring the ability of transferrin to bring iron to parts of your body. This will be high when your total iron stores are too low. Serum iron measures what is circulating in blood on transferrin. Next you want to look at the percent of saturation. If this is low, supplementation may be needed. If you need to take a supplement of iron you should be monitored by your doctor as you can get too much.

   1. Another option here is that you could have an issue with your hypothalamus/pituitary axis. Working on your thyroid and adrenal health will help this a lot. Our adrenals are directly related to the HPA axis, play a big role in managing our blood sugar and also help us respond to stress. If you have any amount of chronic stress at all and consume the standard american diet then you likely will have an issue with this. Diet, again is so important here.

I see so many people struggle with making diet changes and I just want to say that you can do it. YOu have to want to be well more than you want to be sick. You have to want to let go of what is a crutch for some of us- we are not our disease, it doesn’t have us. We can manage it. 

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