How to manage Hashimoto's when you are a workaholic.

A listener writes in about her busy life and how to get help with fatigue, achiness, weight gain and menopause. 

Good Morning Stephanie,

Thank you very much for the ‘Guide’ and for all the information you provide.

I have a topic of interest that you may be able to address.

How to manage your Hashimoto’s when you are a workaholic.

Example: I have a full time job, Mon – Fri, 08:00 – 4:30

                            Part time job, Sat and/or Sun, 07:00a – 7:00p

                            Help husband with his job, about 10hrs week.

Plus all other items relating to running a home.

I don’t have kids but I do have 5 animals. I’m a fur mom. 😊

I usually only have 3, maybe 4 full days off a month.

And – no – scaling back on work is not an option at the moment.

All thyroid labs are good. Doctor says don’t worry about the Hashimoto’s. ☹

History of thyroid cancer, left side removed. Hashimoto’s, Chronic reactive Epstein Barr, risk for Rheumatoid arthritis, and…menopause, lol.

But still very tired, sore/achy, and weight gain after watching diet, trying to get exercise, and taking supplements.

So any insight you could give pertaining to this type of situation would be great.

I’m sure there are others in this same boat as I am.

Thank you again.

You’re wonderful.

Pam

Hi Pam,

Thanks for writing in. I really appreciate it.

Sounds like you have an extremely busy life and not sure how you power through with fatigue!

First thing I would say is, let’s have a look at your thyroid labs and see if they really are optimal. They may be optimal based on the lab values given but they may not be optimal based on what a healthy persons labs should look like.

Of course your doctor says don’t worry about the Hashimoto’s because standard of care in conventional medicine is not to treat it but to up your dose yearly as your thyroid tissue is destroyed. I’ve said that a million times on here so that is old news.

Next is to see if your medication is at the right dose and kind. Many people do fine on T4 only meds like Synthroid or Levothyroxine but a lot of people don’t. It’s clear you will need thyroid meds lifelong based on the fact that you are missing half your thyroid.

Chronic reactive EBV could very well be due to stress or overworking. In this case with the very busy life you have, some adaptogenic herbs might be called for. Potentially Rhodiola, Schisandra, Ashwagandha, Holy Basil or Maca. Don’t just go throwing these in your regime though. It really depends on what is going on and starting slow with one of these like Ashwagandha or Maca first, see how you feel after a couple weeks of taking it and then add in some others. You can order these through my dispensary at https://us.fullscript.com/welcome/hfh

When you have Hashimoto’s your risk for other autoimmune disease raises by about 30% so I will say, not slowing down a bit or at the very least making sure your diet is dialed in pretty much perfectly means your Rheumatoid Arthritis risk is probably higher than most.

Having a history of thyroid cancer is a big deal as well. Make sure you are having tumor markers tested regularly - I would guess this is being monitored but you never know. It should be if it isn’t.

I’m going to do an episode on cancer in general but to make sure your cancer does not come back into the other half of your thyroid OR appear somewhere else, there is a lot you can do in your diet and your lifestyle.

I want to say that I don’t think being busy is bad, especially if you are happy and you have good relationships, especially with your husband and those close to you. Sometimes this matters more than anything else. So if you feel great, have a sense of purpose and community and are truly happy, you are one step ahead of many people in your same situation healthwise.

It would be good to know what supplements you are taking. With cancer being in your past. L-glutamine is a popular supplement but there is some risk it might feed cancer so be aware of that.

Avoiding sugar as much as possible is a good idea - sugar is the main fuel for cancer cells. Your diet should be from the cleanest sources of food that you can afford. Here is where organic matters most. Lots and lots of fresh veggies, dark leafy greens, fermented foods such as sauerkraut and kimchi, bone broth, berries (keep other fruits to a minimum), locally raised organic meats if you can do it. I know this seems ridiculous given the cost of groceries but these are ideal for preventing a recurrence. I can provide meal plans and do so for my clients when they want them so that finding food to cook becomes much easier. Also, given your busy life, some non starchy carbs are probably needed daily to help maintain your energy.

You stated you are still very tired, sore/achy and dealing with weight gain and the most lovely menopause. The weight gain could be menopause related or it could be inflammation. It could be both. Hard to say without looking at your diet and some labs. Feeling very tired could be due to a need for T3 meds or an upping of your dose- again, those normal lab ranges may not be normal. Menopause can also cause joint pain.

If it is your joints that are sore and achy, this can be due to higher levels of inflammation and with menopause we lose some stability from decreased strength and tension in our tendons. If it is muscle soreness and aches then it could be a mitochondrial issue so we would need to look at what nutrients your body might be in need of.

A good fish oil may be in order for you and possibly a broad spectrum one that has omega 3,6,7 and 9. Designs For Health makes one called OmegAvail Synergy which again, you can get by going to us.fullscript.com/welcome/hfh which is my dispensary and gives you a 10% discount. Clients get 20% discount.

If you are not strictly gluten free, I would start with that and see if it improves any soreness you have. If not, try avoiding nightshades like tomato, potato, peppers, eggplant, etc. A quick google search of nightshade foods will help you find a whole list.

If none of this helps the soreness and aches then I would suggest and elimination diet.

You may also want to support your immune system. Looking for nutrient deficiencies is a good first step so that we can identify what your body needs. Things like vitamin A, C, D, or zinc. Maybe you need nutrients to support your mitochondria like B vitamins or maybe you are anemic? There might be more questions than answers here but it gives you something to think about. Here is also where being gluten free will be helpful along with figuring out if there are other food sensitivities. An elimination diet is the best way to know if you have a sensitivity as there is not one really good blood test for allergies or sensitivities.

You stated you are trying to get exercise. What does that look like? I imagine if you are fatigued that exercising is the last thing you want to do. When you have Hashimoto’s or any autoimmune disease, exercising can cause more fatigue if not done right. We have to not over do it. In your case, you might be working so much that exercise of any kind will send you over the edge. I would try for some restorative yoga if that is the case. It is the most amazing kind of yoga where you lie down in specific poses made to help restore your body and energy. And it is worth doing if you can do nothing else.

If you are doing a lot of sitting at your day job or the weekend job then I would make a plan to do some standing when you can. Get a standing desk to do some work at. Walk at lunch during a couple days a week. When you go to the store, park far away and walk from the back of the parking lot. Take the stairs when you can. All of this adds up and is a great first start to exercising when you can.

I hope this helps a bit. I can’t give specific details about what you should be taking as far as supplements go because that would be irresponsible.

Thanks for sending in your question. I love when you guys do that.

I created a new guide for you all called the definitive guide to Hashimoto’s which you can get by signing up for my newsletter. Use the pop up form on my website to be sure you get access. I am not sure the other sign ups on my site have it attached. If you sign up for my email list and it doesn’t show up, email me and I’ll send it to you!

Thanks so much for listening AND for tuning in! I am so so grateful to all of you.

Please share this with anyone you know who is dealing with Hashimoto’s and if you could be so kind to leave a rating and review, it helps more people find the podcast in the sea of millions of podcasts out there.

Why balanced blood sugar matters for thyroid health.

Every organ or gland in the body uses sugar (glucose) for energy production. If you don’t have glucose getting into your cells, you will suffer with low energy. Low energy for your cells but also low energy for you. If your cells can’t be fueled, that will definitely affect your overall energy levels.

If you have low blood sugar, either from not eating enough or from being on a blood sugar roller coaster with the dips of low blood sugar, then your thyroid will not have enough energy to do its job creating a sluggish thyroid.

If you are dealing with insulin resistance at all, (and many people are and don’t realize it) which is when your cells are resistant to the insulin trying to bring in glucose for energy use because there is too much glucose in the blood, then your thyroid will suffer. This is because it too will not be getting the glucose it needs for it to work properly.

In addition, having regularly high blood sugar causes damage to the lining of your blood vessels, your organs, your brain, and causes you to store fat.

High blood sugar causes inflammation throughout the body, including your thyroid so it can’t get all the nutrients it needs to produce thyroid hormones. This will lead to an increased TSH but it might not be high enough for your doctor to say, ‘Oh, you have hypothyroidism’. That said, you also might not need medication for a situation where your blood sugar is affecting your thyroid. You can make some diet and lifestyle changes and get things working better and then retest your thyroid labs. If they get better, then you know what you were doing is right.

Aside from diet, the things that can contribute to blood sugar imbalances are poor sleep. Even just one night of poor sleep can cause short term insulin resistance including in otherwise healthy people. I think of all the nights I slept poorly because my husband snored so loud that I was awake much of the night and if it wasn’t him waking me up, I was waking up because my blood sugar was so low in the night that my body used cortisol to raise it and that cortisol caused me to wake with a start and a racing heart.

Sometimes it still happens to me although very rarely and when it does there is some kind of dream involved that creates the racing heart to wake me up. Only now I can fall asleep pretty quickly rather than when my kids were younger and I was up half the night because of either the snoring or low blood sugar or a combo of the two. My poor kids. They took the brunt of my awful moods due to lack of sleep. Thankfully they have forgiven me and we have pretty good relationships. My life was a huge mess for years because of blood sugar. I don’t want that for you.

When you don’t sleep well, you get no growth or repair which is what is supposed to happen while you are sleeping. This is when your body fixes itself. With blood sugar problems like insulin resistance, you are dealing with a vicious cycle when you are not sleeping.

Stress is another issue related to blood sugar imbalances and poor thyroid function. I feel like a broken record because stress is huge. Again, emotional stress, physical stress, environmental stress. All of it is a problem if it is chronic. Cortisol is a stress hormone. When it rises temporarily, it triggers the liver to make glucose and it can even cause a breakdown of muscle tissue and there is some storage of fat.

If you have chronic stress in your life for whatever reason- it may not be in your control but it will affect you. Your brain senses stress, the pituitary gland sends a signal to the hypothalamus to tell the adrenal glands to secrete cortisol to manage the stress. The pituitary and the hypothalamus are also involved in thyroid hormone secretion. Do you think if the brain is dealing with stress, it can tell the thyroid to release just the right amount of hormones? The adrenals and the thyroid gland are very closely tied together when it comes to function and dysfunction. Very important that the adrenals are not having to deal with chronic stress whether it is from external sources or from imbalanced blood sugar.

When you eat in relationship to when you go to sleep is also very important as well as when you eat in relationship to exercise.

Eating right before bed, especially something that will spike your blood sugar which can raise cortisol which will then inhibit growth hormone (for repairing tissue while you sleep).

If you are not eating protein right away in the morning then your body will take it from your muscle. Protein in the morning is important for stable blood sugar all day long. This is a big deal as we age too because the older we get the easier it is to lose protein. Lifting weights is super helpful, especially as women enter menopause.

How many meals are you eating in a day? Not even meals though, it could just be a problem if you are a chronic snacker. Every time you eat, insulin is released. If you are eating/snacking every hour or two, you are releasing insulin. If you are insulin resistant, that glucose can be stored as fat. Your body needs a break in between meals to burn fat.

A lot of practitioners will tell you to eat 4-5 smaller meals throughout the day to deal with blood sugar imbalances. This is not necessarily helpful. It really depends on what is going on with you and what your blood chemistry says. There are a few different reasons why your blood sugar might be out of whack. Let’s figure that out so we know how to deal with it.

So you have all this imbalanced blood sugar, maybe insulin resistance. This has caused inflammation in the body. You are stressed which can also cause inflammation. Your diet is poor because you are stressed which can also cause inflammation. See how this works?

All of this can lead to gut issues like leaky gut aka intestinal permeability which can lead to food sensitivities and more inflammation and can also create the perfect storm for Hashimoto’s to occur.

Let’s review this quickly.

Blood sugar goes up, it can’t get into the cells because of insulin resistance. Your body senses that the sugar is still in the blood so it raises insulin even more. This leads to glucose to be stored as fat. In addition, when the blood sugar is reduced because of insulin you can get those crashes of low blood sugar which triggers cortisol to try to bring your blood sugar back up but the adrenals release too much which brings your blood sugar up too high and the cycle starts over.

It is vicious.

If you have leaky gut, we need to fix that, figure out what is causing it and fix that inflammation in the body.

You can get a glucose monitor relatively cheap. The strips for it are the expensive part but if you want to really see what foods set off your blood sugar, a glucose monitor is a good tool. You can even do a continuous glucose monitor that you hook up to your phone so it is monitored all the time. You will be able to see some really good trends in how your body responds to sugar. Normal blood sugar hovers around 80-90, 80-100 depending on who you talk to. If your blood sugar is higher than that first thing in the morning, then you have a bit of a problem with insulin resistance. There are other tests that are helpful for looking at blood sugar as well and when you work with a practitioner like myself, they can be good tools to see what kind of blood sugar problems you are having. You can be insulin resistant and depending on what your labs say will determine how you fix it. Even blood sugar issues are not once size fits all.

Other things to consider when looking at your blood sugar dysregulation:

1. Cortisol - is it low? I’m not talking about Adrenal Fatigue because that doesn’t really exist. What I’m talking about is low cortisol. Do you crave salt? Is your blood pressure low? Do you wake during the night- usually around 3am?

2. Are you deficient in certain nutrients? There are things needed to allow your cells to use glucose properly. If you have fatigue or weakness, poor cognitive function, insomnia, muscle cramps, inflamed and scaly skin, hair loss, pale skin tone.

3. Do you have stomach pain, nausea, no appetite, bloat?

4. Maybe you have antibodies to insulin?

5. Frequent need to pee? Hungry after meals? Frequent infections? Fatigue? Gaining weight around your waist? Higher blood pressure.

6. Excessive sweating? Tremors, palpitations? Mood disorders?

7. Body pain, joint pain, muscle pain, fatigue, insomnia, depression, anxiety, mood issues.

Any of these can be causing blood sugar dysregulation issues and should be fixed with a practitioner. I can help you figure out just what might be going on and give you the tools you need to fix these issues with ongoing support. I’m no longer doing one off appointments because this does not help you work through the overwhelm that sometimes comes with diet and lifestyle changes. When working with me you get bi weekly appointments for six months to help you overcome your chronic health issues. If you just need one appointment to send you in the right direction that is available too. This would be for someone who can take the info and run with it. I have found that longer term, having support over 6 months to a year is way more helpful in setting you up for success. If you are ready to figure out what is going on with your blood sugar or your thyroid problems, reach out. Book a discovery call to see if we are a good fit at www.helpforhashimotos.com.

If you wouldn’t mind leaving a review on iTunes, I would really appreciate it. Reviews help boost my visibility so others can find the show. I’m eternally grateful for those of you that tune in. It is my sincerest hope that you find value in each one of these episodes and I work really hard to provide you with good information. This is my job. I’m working for you. Now that I have all of my 1000 client hours needed to get my nutritionist license I am taking on a full load of clients. If you need help, please reach out. If you know someone suffering silently with a thyroid condition, please share this with them. Have them sign up for my newsletter. There is a lot of work to be done to take control of chronic illnesses like thyroid disease and that starts with you taking the first steps to want to feel good again. You are here and listening and learning. You have what I didn’t have when I was first diagnosed. You have a world of information on the internet, a lot of which is crap, some of which is good. As I am learning and growing I will fix what mistakes in information I have talked about in the past. I’m always trying to do better so you have the latest information to get you feeling better.

Wishing you a wonderful week. Thanks again for being here.

What do my labs mean?

Your lab tests are only as useful as their interpretation.  I may have told you to ask for certain labs or maybe you have read on the internet what the best labs to ask for are to figure out why your thyroid isn’t working well.

Maybe your doctor will order the labs you ask for but do they know how to interpret them beyond the standard lab ranges offered? Do you? Probably not. So you have all this information and no plan to get you feeling better.

I’ve even seen functional medicine lab ranges that are more narrow than the standard or conventional lab ranges not be good enough to figure out a problem. The reason behind that is that the functional lab companies are getting their ranges based on the people who are coming to them for tests.

What does this mean? It means that the sick people going to a functional medicine doctor to get their labs are the people who’s results are making the lab ranges. This is true for most labs.

Does that sound like a way to figure out whether or not YOUR labs are out of range or within range? They might be within range of a bunch of other people who feel like crap and don’t know why.

Basic blood chemistry labs like a CBC, CMP, lipid panel, iron panel, thyroid panel can be super helpful but also know that your symptoms matter regardless of what your labs say. The labs are a way to help put the pieces of the puzzle together.

Your symptoms are your body’s way of telling you something is up. They help gauge whether an intervention is working or not. I saw plenty of people who could not help my fatigue because they were not looking in the right place or they were trying to bandaid the symptoms without really getting at the root cause.

Today I wanted to share with you my old labs and how they were interpreted by my practitioners at the time and show you what was missed based on the scientific research based lab values I use.

I was looking in a file cabinet for some financial documents and then got side tracked with all the stuff that could be thrown out in the file cabinet and I came across a green folder with a hand written schedule of appointments for a plan I paid for through a certain chiropractic office. I dug into it and found so much stuff related to my health and trying to feel better over the years. I thought this would make a great podcast episode since many of you have been to multiple practitioners and still feel like crap.

I’m taking you back to 11/25/2011 which is the first wellness plan I found from the 1st holistic practitioner I saw. She was a naturopathic doctor and from what I can tell from my research on her, she was out of ND school/residency about a year or less when I saw her. She was a kind, passionate doctor. I saw her for a few years until it got to be too far of a drive and I still wasn’t feeling great. She was actually on to why I wasn’t feeling great and it was an emotional component I wasn’t dealing with and her suggesting we work on it scared me away. I quit working with her after that and kept looking for the magic pill with other practitioners and never ever felt quite right.

I remember one visit with her where I had brought her a list of supplements I was taking based on testing I had done in my nutritional therapy practitioner training and she said, “I don’t even know what to do with this.”. I could tell she was super annoyed and I get it now as a practitioner because when a client/patient is taking stuff outside of the protocol that was set for them it may or may not be detrimental to the outcome. Plus, you might also just be wasting your money.

Anyway, I went to her for fatigue, hypothyroidism, mood issues, blood sugar issues, and apparently heavy bleeding during my cycle- super heavy. I’m sure there was other stuff but I don’t have my intake form.

Any of this sound familiar to you?

She recommended to me before testing was done:

• Coconut oil for low blood sugar/shakiness

• Flax meal, 1-2 T daily (she suggested mixing in applesauce) all month

• Omega 3: super EFA liquid 1 tsp/day all month

• GLA: 1000mg flax and 1000mg EPO days 15-28

• Vitamin D3: start at 2000IU/day, get tested within 2 weeks

• Probiotics: HMF Neuro caps 1/day

• Acupuncture for mood support

• Labs to get: TPO Ab, Tg AB, FT3, FT4, TSH, rT3 ($155); 25 OH Vit. D, 22IgG Food intolerance test

• See a gynecologist to get pelvic/transnational ultrasound to rule out organic causes of heavy bleeding with menses

• Schedule next appointment in 6 weeks

I did some testing on 12/9/2011: Intestinal barrier assessment 22 IgG through Pharmasan Labs. Just for reference, I was 40 years old (I’m 51 now) and my kids were 11, 9, and 6. I was working as a social worker 20 hours a week and not a very happy person.

Results were:

• Intestinal barrier assessment showed a moderately leaky gut

• Food parameter summary/food sensitivities detected

  • Yogurt was high

  • Baker’s yeast, egg white, tuna, wheat were moderate

  • Cows milk, gluten, goats milk, oats, shrimp were low for presenting antibodies

• Vitamin D test was at 33.3 on 12/8/11 and she told me the range was 40-100

I saw her on 1/2/2012 to go over these test results.

The wellness plan was:

• Avoid yogurt, bakers yeast, egg white, wheat, milk, gluten, oats for at least 4 weeks. Then trial reintroduce the low foods one at a time in this order: oats, milk/cheese- wait at least 4 days in between reintroducing when not eating oats. So eat oats for 4 days, wait four days then reintroduce milk/cheese but don’t eat oats while doing that.

• Breakfast ideas: quinoa porridge, organic chicken sausage, avocado with sea salt, egg yolk

• Flax seeds 1-2 tablespoons/day all month

• Super EFA liquid 1 tsp/day all month

• GLA: 1000mg flax and 1000mg EPO days 15-25

• Vit. D: 10,000IU per day for one month, then reduce to 4,000IU/day

• B6 complex 1/day with breakfast

• Probiotics: HMF neurocaps 1/day

• Slow Flow- use day 1 of period 3 caps every 3-4 hours

• Progesterone cream: day 15-28, stop if period comes before day 28, 1 pump per day at bedtime

• Permeability complex II- 1 cap 2x/day with meals

• She will contact me with thyroid results

• Retest vitamin D in 3 months

• Pelvic/transvaginal ultrasound due to menorrhagia to rule out other causes before getting ablation

• Schedule next appointment in March.

• On the back of the plan was a drawing of leaky gut

The wellness plan for my next visit on 3/9/12 went like this:

• substitute sugar for yacon syrup, read labels and eat less than 20-30g of sugar per day and watch to see how skin reacts.

• Snack ideas: celery/nut butter, carrots/hummus

• Same supplements as before with addition of

  • orthothyroid 2 caps/day

• Remove IUD

• Next visit 8-10 weeks, discuss periods, skin

I’m missing a years worth of labs and wellness plans from her- I do remember her diagnosing me with Hashimoto’s after these thyroid labs were done so I was off to see about medication changes from my doctor because ND’s in MN cannot prescribe medication.

I got more labs done on 1/8/2013 from Pharmasan Labs. The panel was called the Endocrine Health Basic and it was a saliva test.

The cortisol test wasn’t horrible as far as results go- it was a little low in the morning and stayed below range until about 2 pm where it barely went within the range and then was a little high around 9pm. This is a typical pattern for someone with thyroid problems. According to the reference range, my cortisol was below reference range all day long- could be why I was so tired all the time and my blood pressure was super low (I was also freezing all the time).

DHEA was 274.5 with reference range for women at 57.0-615 so that was normal

Estradiol was off the charts low at <0.8 and it should have been between 1.0-14 according to the lab range.

Estrone was 0.8 and that was within the range for my age group.

Progesterone was 566 so high for the range of 38.0-462 but she had me on progesterone cream so I can only imagine that it was probably in range before that.

Testosterone was 26.2 which was also within this labs range.

I wrote her an email on 2/20/2013 saying i got a new presecription for thyroid meds with an increased dose. I got a referral to an endocrinologist which I did not use because I have not found them helpful in the past and they are more expensive to see. I was getting heart palpitations on my new medication so I was taking half a pill and working my way up to a full pill to let my body adjust. I told her I didn’t feel clear headed, probably brain fog, and I was super forgetful and having a hard time concentrating. I said, ‘my kids think I’m crazy’. I told her I was worried about taking a higher dose and asked if I should take it and see how it goes.

She replied that my thyroid needs more support so it might be worth trying to see how my body tolerates it. She wondered if there was something in the medication that my body didn’t like. I believe the real problem was that my cortisol was so off still, I didn’t handle stress well and my body was just responding to the T3 in the new medication. She suggested I ask my doctor for Westhroid or Naturethroid and to ask my pharmacist about the medication I was taking and why I might be having palpitations on it.

I do remember taking Westhroid and doing really well on it and then there was a shortage or whatever and I had to find something else. Story of my life!

On 10/25/13 I redid the Endocrine Health Basic lab panel

• cortisol was within normal range except at 8pm it was high at 3.3 and it should have been below 1.5. She told me to take magnesium at 7pm. I remember the first time I took a powdered magnesium in water. I felt a rush of calm over my whole body from top to bottom. That is the only supplement that has made me feel a physical difference.

• DHEA was at 58.6, remember last time it was in the 200’s. It was still within the normal lab range but much lower this time. My notes say DHEA is a counter balance for cortisol

• All the sex hormones were within the lab normal range. The healthy lab ranges I have are for blood and not saliva so I can’t compare the two. One thing to know is that even functional medicine labs are making their ‘normal’ lab ranges based on the results of people who use the lab. Who goes to practitioners who use ‘functional medicine’ labs? Sick people! I think my hormones were off because I was still a long ways from feeling good with severe mood swings, poor sleep, angry all the time, terrible blood sugar and more.

• I must have had a visit on or around December 4th 2013 because I got a wellness plan via email with 24 things on it

• Supplement protocol changed a bit- ground flax in applesauce was making me throw up shortly after taking it.

  • Floravital iron and herbs at 10ml per day to see if tolerated and reduce dose if it caused constipation

  • NO RAW brassica veggies or soy because they can interfere with thyroid function- we now know this not to be true unless all you ate was brassica veggies and nothing else in huge amounts every day.

  • Add a pinch of sea salt to my water

  • Cornus Sanguinea for autoimmune thyroid support 1 spoonful in the morning (I don’t remember taking this)

  • Adrenal support 2 caps with breakfast

  • EstroMend 2 caps with dinner for memory/estrogen support instead of Femmenesence Pro Peri

  • Take a break from Sepia 200ck for at least one month to see if PMS is manageable without it (she was throwing supplements at this mood problem and nothing was sticking)

  • Repeat thyroid labs in 5 weeks

  • Glutenzyme by Pharmax in case of accidental gluten exposure - at the time we were not sure if I had celiac disease because I never got tested. I felt so good off gluten I didn’t want to go back on to be retested. At this time I was very strict with avoiding gluten.

  • Exercise: do yoga and she wanted me to go to a Qoya class which was about a 40 minute drive for me from my house and I never went. I don’t like driving that far for a workout- even now, my gym is 5 minutes from my house.

  • Grounding/visualization: imagine roots growing from your feet that firmly connect you to the earth. I still do this when I feel stressed. She said the roots provide you with nourishment/energy and offer a way to release any unwanted energy back to the earth to transform it.

  • We discussed removing my mercury fillings from my teeth.

  • Return visit in 8 weeks.

The next set of labs is from 11/26/2014 so almost a year later. By this time I probably did have my fillings removed. I did 1/4 of my mouth at a time with a dentist who knew how to remove mercury safely.

By this time I had found an MD willing to treat my symptoms along with my labs and I don’t think I was seeing the ND anymore- she was too far away for me. That said, I was driving almost an hour to the MD but she took my insurance so the visits were way cheaper. I had also gotten my nutritional therapy practitioner certification by this time. The notes on the reason for the visit was that I was here to check on thyroid, I fell really good, not fatigued, sleeping 7-8 hours, feels well physically, stress is reduced, had heart palpitations when tried raising dose of thyroid meds last time. This doctor was the only doctor in her practice willing to use something other than levothyroxine to treat thyroid so I tread lightly with her in order to continue to get the meds that made me feel good. I’d also make a note that I was not feeling tired even though my iron levels were super low- I think this was attributed to being filled up with friends in a community of like minded people who I really enjoyed. I had previously lost a friend group in 2010 and had found friends through my certification program.

• FT3 2.0 (lab range 2.0-4.4) normal but low by my ranges

• FT4 0.74 (0.82-1.77) low by lab and my ranges

• TSH 5.070 (0.450-4.500) High by lab and my ranges

• TPO Ab 69 (0-34) high

• Tg Ab 1.0 (0.0-0.9) high

• RT3 11.4 (9.2-24.1) lab range only

Again, these are lab ranges here that are done on probably both healthy and sick people because it was the lab at the doctors office though some of this, like Reverse T3 and the antibodies may have been sent out to Quest diagnostics. Had my doctor used the ranges I have which are based on healthy people and from the research, it may have painted a different picture. Here I have low T3, low FT4 and High TSH which indicates I’m not making enough T4 and not converting it for whatever reason. My meds were raised.

Fatigue was back with a vengeance and by January 2015 I was going to a chiropractic office that had a medical doctor on staff. My hope was that I would be able to see the doctor and have him prescribe my meds. The funny thing is, I never asked the chiropractor if I could do that. I just assumed. When they presented their plan and the cost, there was no mention of the doctor. I figured out later, he was a place holder so they could do certain things in their clinic that needed an MD on staff. I don’t think he was ever there. I didn’t have my voice, I was too timid to ask about seeing the doctor.

So for this office, their treatment plan was for my complaints of low energy, anxiety, brain fog, constipation. Based on my history and his exams he recommended the Nutritional Function lab test, GI Effects Stool test, Cyrex Array 4 for food hypersensitivity with the knowledge that I may need further testing based on the results of these tests.

Their plan included 6 visits with the nutrition chiropractor and 16 visits doing oxygen therapy which was their fix for my fatigue. He put me on the Apex Energetics RepairVite Diet and their powder. I did feel really good after this diet but it was restrictive. They used the IFM MSQ each visit to see how things were either improving either for the better or worse. In 2015 this plan cost me $1235 after discounts.

They did a body composition by hooking me up to some electrodes and having me lay on my back for around 10 minutes or so. I got a super fancy report showing my BMI at the time was good. It also had something on it called phase angle and mine was low. This report indicated that that is consistent with cell death or cell breakdown which could very well have been the case. I was thin and tired and brain foggy. It is said to be a predictor of malnutrition and I do think at the time I was not absorbing nutrients really well. It also showed that I was about 31.4% body fat so likely losing muscle and what you might call skinny fat. All that from a really fancy nine page report.

I did have my blood drawn for a CBC at their clinic. They didn’t give me the actual results but a fancier paper with each marker, my lab value, functional ranges and laboratory ranges. The entire thing was highlighted line by line in green for normal, yellow for out of the functional range and red for out of the laboratory range.

This blood draw was from 2/24/2015 - I was originally going to go through each lab marker and tell you the differences between their lab range and my lab ranges but I think that is going to be too much so I’m going to skim over them. The point I’m trying to get across is that this chiropractor missed some things that I would catch with my lab ranges. These things would be minor for the most part and could be fixed with some diet changes and supplements.

They missed low albumin, high AST and ALT liver markers, low sodium, high CO2, high bilirubin, low glucose, high HBA1C, low HDL cholesterol, high iron, low ferritin, low neutrophils, and high lymphocytes. They had shown high monocytes and eosinophils where my ranges said they were normal.

When the lab ranges vary so crazily from lab to lab and practitioner to practitioner, things can get missed. The blood chemistry training I received from my former professor allowed me to get scientific research based lab values on healthy individuals that are sound with ranges tight enough that I’m able to catch things before they get bad so to speak. This lab also showed TSH was a little high and T4 was low which would indicate I was in need of an upped dose of medication which I could not get from them because their doctor on staff was not actually on staff.

I was more mad at myself about that whole doctor thing because I didn’t have the confidence to ask them about it. I was intimidated by the chiropractors for some stupid reason. Things would definitely be very different now- I have found my voice! I would have questioned them about seeing the doctor. I was just so desperate at the time.

They also had me do a Cyrex Labs Array 4 - Gluten Associated Cross Reactive Foods and Fodds Sensitivity which is for IgG and IgA antibodies. Nothing was out of range but soy and corn were considered to be just slightly out of the normal range. He put me on the RepairVite diet for 3 or 4 weeks then when my MSQ showed I felt really great he told me I could go back to my normal diet. That was it. According to him my gut was healed.

Next was a Genova Diagnostics GI Effects stool test. A huge fancy report with graphs and pictures in color on the first page that told me nothing. I had undigested fat in my stool and some species of bacteria were low. So the solution was to take HCL with meals.

They also did a comprehensive melatonin profile which came back normal. I think he did that one because I was so tired. Remember that they missed low ferritin which will make one tired so I think this test was a waste.

In April 2015 they had me to the Adrenocortex Stress Profile which is a saliva test. It showed my cortisol was high all morning and high normal in afternoon and normal at night. I think the stories in my head contributed to my stress levels. I was not a happy person and I was wound up pretty tight.

Once I was done with their program I told them I was still fatigued and they told me to go back to my doctor to have my thyroid checked. And that was it.

I was back at my doctor that took insurance in August 2015 and had a CBC done again. There was about a 5 months difference between the two labs and this one was showing anemia and likely micronutrient deficiencies. RBC, Hemoglobin and Hematocrit were all low and MCV was high by my ranges all of which indicated I needed some nutrients. I had my B12 tested too and it cam back normal by the lab range. I don’t have a different range for that but it would be interesting to dig through the research which I might do at some point. All of this would point to fatigue for sure but it was missed by my doctor.

Same doctor tested my thyroid on October 6, 2015. FT3 was normal (low by my range) at 2.0, FT4 was low by both ranges at 0.74, TSH was high by both ranges at 6.130. I was on naturethroid at the time and struggling with palpitations when the dose went up so this is when I started splitting the dose and taking it twice a day. When TSH and T4 are low it could mean an iodine deficiency (not likely though I was not eating a lot of processed foods and using sea salt), autoimmunity- so antibodies could be high, and there was likely less conversion of T4 to T3 because there was less T4. There was a definite thyroid gland dysfunction.

Fast forward to April 2017 when I had my blood and urine tested for life insurance.

By my ranges, glucose was low, BUN was low, Creatinine low, Uric acid low, bilirubin low, liver enzyme ALT high, AST high normal but better than the previous years labs, GGT low (indicated oxidative stress), protein low (low by their range too), albumin low, globulin low normal (low by their standards), calcium low, LDH low (indicative of glucose issues), HDL low (inflammation), cholesterol/HDL ratio leaning towards an increased risk of CVD. They missed a lot of stuff with their ranges and I got the best life insurance rating you can possibly get.

My latest labs were done at my last visit to get my prescription renewed. I’m grateful to have a quality nurse practitioner willing to work with me based on my symptoms. She is cash pay though so I do pay out of pocket every time I see her. She is also functional medicine trained. The first time I saw her, she had me do a Dutch test and a Cyrex leaky gut panel- that was around $1000 for the two tests. I didn’t learn much from either- stuff I kind of already knew. I also did a food sensitivity panel from Cyrex that came up positive for foods I had been eating a lot of and tuna and shrimp. Since those two were on that very first food sensitivity panel I did back in 2012 I wonder if there isn’t some significance to that.

I did a gut healing protocol- a mix of following her recommendations and my own gut healing protocol from my GI class. It worked. I have been able to reintroduce dairy on a limited basis, meaning I don’t eat it every day, and nuts.

Back to my latest labs- done in April 2022. I compared them to the labs I had done July 2020 which was fun for me given my blood chemistry background.

What was missed?

Everything came back normal according the the lab values from the lab which was Quest Diagnostics.

My lab ranges revealed some white blood cells were high indicating a potential for low cortisol, a virus, parasite, and general inflammation. My blood sugar was low at 70 but can be low if cortisol is low or in hypothyroidism. My HDL cholesterol was low indicating the need for gallbladder support and triglycerides were high which can be high if there is hypothyroidism or elevated estrogen. My cholesterol to HDL ratio was high which can indicate an increased risk for cardiovascular disease.

My calcium was low indicating potential need for getting more in my diet or poor absorption. It could also be a mineral deficiency but I can’t confirm that because the minerals were not measured.

Creatinine was low which would either be decreased muscle mass or poor protein intake. LDH was high which can be high with hypothyroidism and my TSH was 20.39, FT4 0.7, FT3 2.2.

Clearly my thyroid labs say I was hypothyroid which affected the results of my other labs.

Why was I so hypo? I forget to take my afternoon dose of NDT a lot. I retested in June of this year after being more diligent about taking that afternoon dose and my TSH was 0.44, FT4 1.1, and FT3 3.7.

Why did I share all of this with you?

So you know you are not alone on this journey. I get what it feels like to feel bad.

I’ve done the work to understand what your labs might be saying about what’s going on in your body and I can help you figure it out.

I also want to point out that a lot can change in a couple of months of giving your body what it needs or what it is asking for so one bad lab result does not mean you are doomed. That lab draw is just a picture in time of what is going on and retesting with the same labs after a couple months of changes can help me see if things are going in the right direction.

Let’s figure this out together. I am on your team.

Thanks for tuning in.

How do you push through the fatigue? Episode 13.

Q.  How do you push through the fatigue? I just want to get my life back on track.

Q.  I’ve got hypothyroidism/Hashimotos. Around noon I start getting tired and it can get to the point of dozing off. I've had every thyroid level possible checked and it's within normal range. We've actually checked it numerous times. I've had my b12 and folic acid checked along with my hormone levels, vitamin levels, and had a CBC done. Everything is good. I'm wondering if maybe we are missing something. Could I have something that we haven't checked for yet. I've also got bipolar2, depression/anxiety and ptsd which I take Topamax for. I also take Levothyroxine for my hypothyroidism.

First let’s talk about Topamax. I want you to know what you are on.  Your doctor should be testing your kidney and liver function and your blood should be tested to be sure you are able to process the drug well. They can become toxic very quickly.  

You should not drink alcohol while on this medication as it interferes with the effectiveness and it can make you sleepy as well as slow your heart rate. 

Antacids will keep you from being able to absorb this medication as well as any nutrients from your food. 

Fiber supplements can reduce the effectiveness of this medication. 

This drug will cause you to be low in folate or deficient in it. 

It has not been approved to treat PTSD but is endorsed by the National Alliance on Mental Illness to treat bipolar disorder and other mood disorders. 

Common side effects: 

Diarrhea, Dizziness, Double vision, Fever, Hair loss, Loss of appetite, Mood changes, Nausea, Reduced perspiration, Sinusitis, Stomach upset, Taste changes, Tingling or prickly skin sensations, Tremors, Uncontrollable eye movements, Urinary tract infection, Weakness, Weight loss.

With that being said, let’s move on and talk about fatigue. 

This is a super common issue for those of us dealing with thyroid issues and there are a number of reasons why fatigue could be your issue. 

Anemia.

You can have anemia from a deficiency of B12, Iron or folic acid. Your doctor may check your iron levels but do they check B12, folic acid and ferritin? Any one of these can contribute to fatigue.  And just because your lab says you are in the normal range doesn’t mean you are in the optimal range. j

Normal ferritin levels are between 12 -150 ng/mL. Mine is currently at 17 and I struggle with energy often. Some thyroid experts would say that optimal ferritin levels should be at 90-110 ng/ml for good thyroid function.  If you are still losing your hair- it could be an iron deficiency. 

And B12 values from your doctors lab may include values from people who were deficient in B12 so you can’t always rely on the lab values. “normal” is between 200-900 pg/mL but under 350 can give you neurological symptoms.  

Food sensitivities, not food allergies which is when your immune system reacts to protect you like when someone’s throat closes off in a nut allergy.  This alerts the IgE part of your immune system and happens as soon as a food is ingested. The IgA and IgG sections of the immune system will react to foods in what I would call a sensitivity or intolerance. These can cause us to be fatigued. 

IgA reactions happen in the intestinal tract which can cause inflammation there each time we consume a particular food. This will damage the intestines and can cause us to be unable to absorb nutrients from our diet. You may have symptoms like diarrhea or looser stools, constipation, reflux or you may not have any symptoms at all. You can end up with conditions like IBS, gas, rashes on your skin, acne, asthma, headaches, irritability and fatigue.  Celiac disease is in this category. 

If your T3 is low and you have high Reverse T3, this will affect your energy. T3 helps our cells make more energy. Reverse T3 makes T3 ineffective so that we are slowed down a bit. If Reverse T3 is high, we will not have any energy and one of the biggest reasons this might be high is due to stress. Another problem could be that you are not converting T4 into T3. This can be due to stress, or even nutrient deficiencies either due to low stomach acid or a compromised gut. You might find you need to be on a medication that has T3 in it. 

If your TSH is high, you will not have energy. Not all lab values are created equal here. You need to make sure that you are in a good range. Lab values for TSH are made up from a population of all kinds of people- those who are seemingly healthy and those who have undiagnosed thyroid problems and even the elderly who often have lower functioning thyroids.  The best reference range for most people is to have a TSH around .5-2 uIU/L. Personally,  mine is lower than .5 and I feel pretty good on that.  If you are taking NDT you can have a TSH that might look hyper and if your T3 is in normal range you probably feel pretty good. This can cause alarm with your doctor but try to have a conversation with them about it. 

How is your blood sugar?

This is a really really big one because it affects our adrenal glands which also have a role in energy. The good old blood sugar roller coaster will cause your adrenals to become weaker or cause the signaling between your brain and your adrenals to not work well leading to what is called adrenal fatigue or HPA axis dysfunction. For people like us with Hashimoto’s we may not tolerate those refined carbohydrates very well at all. Sometimes we get a big release of insulin when we consume sugary or refined “white” foods that others might not. So our blood sugar goes up really fast and we may have too much insulin in our blood which causes us to crash with fatigue and even anxiety or nervousness. This stresses our adrenals and leads to more fatigue.

Adrenal health is important for energy. If you are suffering from Adrenal fatigue you likely don’t have much energy to speak of even if this is the only thing you are dealing with. This is such a big deal and it takes some time to bring your adrenal health back in good standing. You need to avoid caffeine, keep your blood sugar balanced, make sure you are sleeping well and resting when you can, managing stress and probably supplementing. You can listen to Episode 7 of this podcast for more on adrenals. 

Having good digestion is key to energy. 

Many of us will be nutrient deficient and usually deficient in those nutrients that help our thyroids to function well. Just having hypothyroidism makes it harder for us to get our nutrients out of the food we are eating. This means the digestive system has to work a little harder to break down our foods and this can cause a lot of fatigue. We often have lower levels of stomach acid and most of us don’t eat when we are relaxed and we certainly don’t take the time to chew our food well. Right there is three strikes against us in the energy department. 

When we are not relaxed when we eat, we are not in “rest and digest” mode or what is called parasympathetic mode. This means we are in fight or flight mode which is not a good environment for good digestion. We already are not making enough stomach acid because we have symptoms of hypothyroidism, then we are not relaxed so we make even less. Then we are not chewing our food well- like 20 chews per bite to break it down. So, we have all this food in our stomach, not enough stomach acid and it is not being broken down. Our digestive system is working extra hard to try to break this stuff down- using all kinds of extra energy and that makes us tired. Then you have undigested food going through your intestines. You have leaky gut or intestinal permeability and these undigested food particles are then getting in to your blood stream causing your immune system to go on alert and inflammation occurs in the body. Fatigue is going to be a factor here. 

If you have low vitamin D, you can have fatigue. Get some sun. Lay in the sun for 10-15 minutes or go for a walk on a sunny day and expose as much skin as possible. Take a supplement of D3 if needed and make sure to have your levels checked by your doctor. Low D is a factor in autoimmune diseases like Hashimoto’s. 

A good diet will go a long way to helping you with your energy problems. High quality proteins and veggies along with a small amount of fruit. The big foods to eliminate for us are going to be gluten, dairy, eggs, nuts and I would try to eliminate nightshades to see if you feel better. This is basically called an elimination diet and is important for you to start to feel better, have more energy and bring your body back in to balance. 

You can find Hydrozyme at www.getbiotics.com use code DFILC163 to access.