Endocrinologists, medication, and first steps to take when diagnosed. Episode 9.

So today I had my 3rd consultant appointment to tell me I have hashimotos disease. (I got told this by the doctor 3 months ago) all he said was, its fine, Nothing to worry about and its very common in women, thyroid is fine, no need for anything else other than ill see you in 9 months time......now i feel like an idiot for having bad days of constant tiredness and pain.

After receiving the results from my full thyroid panel that was ran by my gynecologist, she referred me back to my regular doctor. She spent 10 minutes confirming that I do have Hashimoto thyroiditis and hypothyroidism. She said that I need synthroid and I should follow-up in 3 months. Nothing was explained to me. No recommendations for supplements. No recommendations for diet. I had to request an endocrinologist referral, which will take weeks. So my question here is should I begin the synthroid, figure out what supplements I need, diet, etc or wait to start synthroid until I meet with endo? I’m lost. Also, the closest functional medicine doc is 2 hours from me and doesn’t take insurance.

It seems this is quite common for a lot of us. We go to the doctor and they tell us to take the medicine and come back in three months or so to be tested to see if we are at the right dosage.  I personally got nothing at all from an endocrinologist. I had to pay out of pocket to see him and he was worthless to me. Just because your thyroid is a part of the endocrine system does not mean you will get the proper care from an endocrinologist. I am sure there are great ones out there but I have found they are particularly difficult to work with you on treating symptoms and not just your labs. Plus they have a standard for their labs and they will go by that and nothing else. If you are lucky to find an endocrinologist who will work with, great. If not, fire them and keep looking. You are the customer in this situation. You have a right to find someone who will listen. Unfortunately I realize that some of you have horrible health insurance and don’t have the ability to look around much so I have a plan for you! 

First of all, you have to remove any triggers for the disease. This will be different for each of you. Once you find our what your triggers are then you will have to repair that which brought your body out of balance and led you to your autoimmune condition. Why is your immune system out of balance? Why did this happen. These are questions you need to ask yourself and do a little digging. 

Make a timeline of your health. Look back to as far as you can remember and write it all down in a timeline. Infections, times where you were severely stressed out, antibiotic use or other medications you took, were you on oral contraceptives? Any accidents? Have you ever been exposed to any toxins? How about heavy metals? Do you have amalgam fillings?  Once you make a timeline you can see where things might have started to go wrong and then how to fix them. Obviously you can’t do anything about an accident or the fact that you took antibiotics but you can manage stress, take probiotics and other nutrients such as b-vitamins. i strongly recommend working with a practitioner on this to get it right. You don’t and shouldn’t just take any old supplement just because someone says you should. Don’t waste your money on things you may not need. 

Next, know that synthetic T4 only medication is not the only one on the market and it doesn’t work well for some people. Ask your doctor to let you try natural desiccated thyroid hormone like Armour or WP thyroid or any one of the other ones on the market. 

Also, you must take a look at your diet. This is always the very first place you should start. What are you eating?

A gluten free diet is a must in my book. There is so much research now on the effects of gluten and what is now believed to be the glyphosate in the wheat products that is destroying our health. Gluten also affects our gut health in that it plays a role in leaky gut or intestinal permeability which allows undigested foods or proteins to exit our intestines and go in to our blood stream setting off an immune reaction which can lead to food allergies or sensitivities. 

You may have to eliminate other foods too. Most people also have to eliminate dairy products and some of us don’t tolerate a whole bunch of foods. An elimination diet is a good first step really but if that seems overwhelming to you then start with gluten free and work your way there. Removing these foods that are causing inflammation in your body will allow your body to calm down and begin to repair itself. It will also provide your body with a chance to properly react to a food that is harming you so when you reintroduce foods you should be able to tell if something is working well for you. Foods can affect our mood, our energy levels, our digestion, our skin, our brain and more. Keeping a food journal is a good way to really pinpoint what foods are not working for you when you reintroduce them. 

The quality of your food is also very important. People often say how expensive it is to eat healthy and I’m not gonna lie. It can be costly to eat all organic and shop only at food co-ops. I have been very fortunate to be able to do just this but I also don’t have a lot of extra money for anything else. I have made high quality foods a priority and will continue to do so because it is important to me. It may not be important to you and that is okay. You can do a lot of good for your health by shopping at a regular conventional grocery store. Just don’t shop the center aisles of the store. In other words, buy real whole foods and if you can, shop with the environmental working groups list of dirty dozen and clean fifteen. This is a list of produce that is recommended to be bought organic and a list of produce that is okay to buy conventionally grown. A big way to save money though is at farmers markets. I got a head of cauliflower for $1 and all kinds of things at much cheaper prices than were in the store. I also buy most of my meat from local farmers at a significant savings. So if you can do some of that kind of thing it is really helpful in saving money. 

Next, if your adrenal glands are not working properly, you will not see improvement in your thyroid health. When we are stressed our cortisol can be low or high or fluctuate between the two. Last weeks episode was about adrenals so you can give that a listen for more details. 

You also need to heal your gut where 80% of your immune system lies. Cleaning up your diet, making sure you digest your food well, maybe taking a stomach acid supplement. If your stomach is not acidic enough you will not digest your food which will start the cascade of inflammation through the digestive tract and the body. A good diet is essential here and probably some supplementation. You should work with a practitioner on this. 

Lastly, removing toxins. This is big. Maybe you have a heavy metal issue. Maybe you need to clean up your personal care products and your household products. Perfumes have too many chemicals in them to count so those should be avoided. Air fresheners are full of chemicals. Anything you put on your skin will be absorbed in to your blood stream so you need to be mindful of that. 

I could probably spend an hour on each of these subjects but I like to keep these episodes kind of short since many of us have brain fog and low energy.  

You should take the medication that your doctor prescribed and see how you feel. Some people are sensitive to fillers in some of the medications. Synthroid contains cornstarch. Some generic brands have blue food dye in them. Many people do better on natural thyroid hormone replacements like Nature thyroid and Armour but everyone is different.  It is common for people with Graves disease to do better on T4 only meds like Synthroid rather than meds with T3 in them because they will have developed antibodies to T3 and T4. Because T4 is synthetic in synthroid there is less of an autoimmune effect in those cases. 

If you are taking synthroid or other synthetic T4 only medication and you show a normal TSH lab test but dont’ feel any better this might be what is happening: 

If you have hashimoto’s, long term inflammation of any kind including stress you can end up not being able to convert T4 to T3. You pituitary gland wont’ communicate well with your thyroid gland and/or your cells won’t respond to the thyroid hormone that is brought to them.  You may also have issues with your blood sugar, a gut infection, food intolerances and so on. 

If you are taking or feel better on natural desiccated thyroid hormone then: 

you probably couldn’t convert t4 to t3, you were sensitive to something in the medication, you may need t3 because those cells of yours are not taking in the t3 brought to them or the cells just like t3 better. 

If you have high cortisol, low progesterone, inflammation, nutrient deficiencies- these all will play a role in your body’s ability to take in whatever medication you are taking. 

Something else to consider is that if your autoimmune condition is managed you might not need medication at all. When your thyroid gland is significantly damaged then you will probably be dependent on medication and not taking it can be life threatening. 

Either way, you have to manage the hashimoto’s with all that was mentioned today. It is a lifestyle folks, not a quick fix. Healing or recovering or putting hashimoto’s in to remission takes time. The better you do with diet and lifestyle the better your thyroid will perform for you. 

To me, it is all worth it. 

That’s it for today. Thanks for listening. Be sure to share this podcast with anyone you think could use it. My goal is to help as many of you with hashimoto’s and other autoimmune conditions as possible. 

Be sure to pick up my free ebook, 5 Things Your Doctor Won’t Tell You About Hypothyroidism on my website www.outofthewoodsnutrition.com or www.helpforhashimotos.com  

You can find me at Out of The Woods Nutrition on Facebook www.facebook.com/outofthewoodsnutrition and at @stephanieewalsntp on Instagram. 

Please send me your questions about thyroid and hashimoto's or anything autoimmune related to helpforhashimotos@gmail.com or fill out the contact form on my website. 

Again, you can get $15 off your first order with www.paleoonthego.com with the code GETCLEAR

Also, I would appreciate it if you left a review on Itunes for me so more people can find this podcast. It would really help me out! 

Thanks. 

Links (some are affiliate) to stuff I talked about: 

Eat Wild

Make-up and Skin Care

Mrs. Meyers

Branch Basics

Hot Logic

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. 

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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. 

Pork Patties with sweet potatoes recipe

Chicken Hashbrown recipe from The Healing Kitchen

Hidden Sources of Gluten in The Paleo Approach

Introduction: Help For Hashimoto's Podcast. Episode 1.