There is no question that exercise is a very important part of any healthy lifestyle. This is especially true if you have an autoimmune disease. However, when you exercise with Hashimoto’s you must be careful to do it properly or you can wind up doing more harm than good.
In this post we examine new research on exercise and look at the best type of exercise program for people with Hashimoto’s.
Exercise has many health benefits and many of these are hugely important if you suffer from Hashimoto’s. In my last post, I mentioned a lecture I attended that was taught by Dr. Datis Kharrazian, here is some additional information I learned and how I think it applies to Hashimoto’s people. According to Dr. Kharrazian, the benefits of exercise include:
* Growth Hormone Release
* Opioid Response
* Nitric Oxide Synthase (eNOS) Responses
* Brain-Derived Neurotrophic Factor Release
* Insuline Receptor Sensitivity
* Immune Enhancement
Growth hormone stimulates cell reproduction and regeneration, and growth in our bodies. It also has a number of positive effects on our nervous, endocrine, and immune systems
A lot of growth hormone’s effects are felt in the liver where it can improve the burning of body fat, improve blood glucose levels and increase protein synthesis.
It also has important effects on the nervous system where it can improve synapses in the brain. It also improves heart function, immune function and decreases recovery time.
In addition, it has been found to increase calcium absorption and improve bone density.
Studies have shown that growth hormone release is increased with increased exercise intensity. (So walking on a treadmill and watching t.v. probably won’t result in much being released.)
Hypothyroidism can cause increases in body fat and alter lipid metabolism, and can lead to poorer absorption of calcium and protein. So these effects can be very beneficial for Hashimoto’s patients.
Exercise has been found to release the body’s natural opioids called endorphins and enkephalins. This is commonly known as the “runner’s high” or that blissful feeling that you get after certain kinds of exercise and sports.
Endorphins have many positive effects including pain relief, stress reduction, and improving our moods. Exercise can also result in the release of more dopamine and serotonin both of which are responsible for happiness and satisfaction with life and relationships.
Studies have shown that moderately high to high intensity exercise stimulates the release of these natural proteins. It also seems to depend on the individual with some people needing to do more than others.
Hypothyroidism can lead to declines in dopamine and serotonin and to feelings of depression and overwhelm. Some of the most widely prescribed drugs for Hashimoto’s people are anti-depressants, so exercise can have huge benefits for these people, as well.
Nitric Oxide Synthases (NOS) are enzymes that can do both good and bad things in the body. Increased eNOS (endothethelial NOS) increases blood flow which can get more blood to the brain, can improve heart health and can get more nutrients and oxygen to our bodies’ cells. This results in tissue repair and more energy.
Increased nNOS (neuronal NOS) causes more muscle contraction and brain focus which results in improved performance in various activities.
On the other hand, increased iNOS (inducible NOS) can result in a host of bad things like: surges in destructive immune cells called cytokines, damage to mitochondria and inflammation. Too much of this can lead to injury, muscle wasting and breakdown and pain.
(Arginine is an important nutrient for iNOS and should be avoided before exercise.)
NOS plays a key role in cardiovascular, immune and brain function. All things that can be compromised in Hashimoto’s people.
It seems that the right amount of exercise is key for getting the right amounts of the right kinds of NOS. Too little and you won’t get the benefits, too much and you get the damaging consequences mentioned above. One again, the key is high intensity, but not for too long.
BDNF helps with nerve growth and differentiation in the brian. It is very important in building new nerve pathways and preserving and keeping healthy old ones. So it is critically important in maintaining a healthy brain and in slowing the destruction of nerves in the brain that can lead to dementia and Alzheimer’s.
Exercise increases levels of BDNF and also improves brain function. Once again (are you seeing a trend emerging?), the amount released is dependent on the intensity of the exercise.
Brain fog and neuro-degeneration are very common complaints from people with Hashimoto’s. This is caused by numerous things, but the underlying mechanism is inflammation caused by immune cells and the destruction of brain cells.
Problems with insulin resistance are very common in today’s society and are a driving force in the initiation of Hashimoto’s. It can also prevent people from getting any better once they have developed the disease.
Insulin normally helps sugar get into cells, when people become insulin resistant because they are exposed to too much sugar, the cells of the body start blocking insulin because they can’t deal with so much sugar.
This person feels like she needs to nap after every meal, and may actually fall asleep after eating a carbohydrate rich meal. This person will also have belly fat and will complain of insomnia.
Insulin resistance can drag down thyroid function and contributes to diabetes, heart disease, sleep apnea, hormone problems, obesity and certain types of cancer.
Aerobic and strength-training exercises improve insulin sensitivity by increasing the number of protein molecules called glucose transporters (GLUT), which allow your cells to better respond to insulin.
Hashimoto’s is an autoimmune disease. The immune system has short circuited and attacks the thyroid as if it were a foreign invader.
Exercise can be very beneficial for improving immune function. The right kind of exercise can be helpful in healing the gut and in improving gastrointestinal immunity. Since 70% of the immune system lives in the gut, this can be very beneficial.
But, excessive exercise can actually cause major problems with immune function. And if you have Hashimoto’s it is very important not to overtrain or you can wipe out all of the benefits and actually make many things worse.
It is clear that exercise can be very beneficial for Hashimoto’s patients, but what is the right kind and the right amount?
According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:
* Break a sweat after 3-5 minutes
* Breathe deeply and rapidly
* Only talk in short phrases while you are doing this.
You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.
There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.
The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.
This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.
Dr. Kharrazian also noted that there are a number of things that can make exercise not work for you. If you have any of these conditions, you must be very careful not to overdo it when working out.
These conditions include:
* Pre-existing high or low cortisol levels
* Pre-existing systemic inflammation
* Pre-existing immune weakness
* Pre-existing intestinal permeability
* Pre-existing hormone imbalance
* Pre-existing nutrient deficiencies
* Pre-existing obesity
People who suffer from Hashimoto’s often have a majority of conditions from that list, which means they are very vulnerable to getting worse as the result of exercise.
There are a number of signs and symptoms that can help you identify if you are working out too much.
Performance Signs and Symptoms
If you have a hard time recovering from workouts, can’t complete your workouts, notice your performance is declining or that you have more injuries then you may be doing too much.
Psychological Signs and Symptoms
If you are exercising frequently and you notice a loss of motivation and enthusiasm, a loss of competitive drive, depression, irritability or aggression for minor reasons then you may be doing too much.
Physical Signs and Symptoms
If you are exercising regularly and you notice that you have a weakened immune system, a loss of libido, loss of menstrual cycle, decreased muscle strength or unexplained increases or decreases in weight then you may be over doing it.
The Best Workout: Maximum Results With Minimal Energy Expenditure
An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal offers an example of an optimal 7 minute workout that can be used as a starting point for Hashimoto’s patients and can be utilized to achieve all the health benefits without causing any of the negative effects of overtraining.
I really like this workout because it can help you achieve all the health benefits we have discussed in a very short time, it works on your entire body and it can be modified so that you can do more or less.
This entire workout can be done at home, in a hotel room or anywhere that has an open room and a chair. You don’t need to purchase any equipment and you can do it by yourself without having to hire a personal trainer or therapist.
The entire workout is 7 minutes and you can repeat the circuit up to 3 times. It consists of 12 different exercises each done at high intensity for 30 seconds.
For people with Hashimoto’s, I recommend starting with one cycle and seeing how you feel. For some, even a 7 minute workout will prove to be too much. If that is the case, cut the 30 second intervals in half.
If you are able to do all 12 exercises as suggested for 30 seconds then do one interval for one to 2 weeks (a minimum of 4 times per week). Repeat the entire sequence after 2 weeks and then add a third repetition after an additional 2 weeks. If pressed for time, you can simply do 1 round of 7 minutes.
The optimal time to get most benefit is within 10 minutes after you wake up, before you have had breakfast. This is the perfect time to exercise because you can take advantage of your body’s natural cortisol surge and exercising before breakfast will also help you burn fat more efficiently and help reduce insulin resistance.
For my patients and myself, I recommend taking a drink that provides electrolytes (not Gatorade – which is loaded with sugar). Here’s a recipe for a simple Electrolyte Lemonade:
Electrolyte Lemonade:
3 organic lemons, peeled, but leave white pith intact
3 tablespoons coconut oil, olive oil or flax oil
1 organic pear, cored
1 tablespoon Celtic sea salt or Himalayan Salt
6 cups filtered water
Blend everything well in a Vitamixer, makes 1 pitcher
Drink 1 glass before your workout.
It is also recommended to support nitric oxide synthase production. The following nutrients and co-factors can do this: ATP, N-Acetyl L-Carnitine, Huperzine A, Alpha-GPC, Vinpocetine and Xanithol Nicotinate. This will help boost eNOS and nNos.
After the workout take something that will reduce inflammation and support the immune system like turmeric and/or resveratrol and another glass of electrolyte lemonade.
Hashimoto’s is a complicated condition that can impact all the major systems of the body. In order to treat it effectively, you really need to adopt a lifestyle that supports you with the right kind of diet, exercise and supplement regimen to get you feeling your best and to slow or stop the destructive progress of the autoimmune disease.
Would like help in designing the right kind of diet, exercise and supplement regimen from someone who has worked with over 2,000 people with Hashimoto’s?
I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Opioids and Exercise. An Update. Sports Med. 1989 Feb;7(2):109-124
Life Food Recipe Book, Annie Padden Jubb and David Jubb, North Atlantic Books, 2003, page 186, Electrolyte Lemonade
Hashimoto’s is the most common autoimmune disease in the United States. And one of the most common complaints for people with Hashimoto’s and hypothyroidism is that they have difficulty with weight loss.
This is even true for people who are taking thyroid replacement hormone (especially T4), exercising and eating well. It seems that no matter what they do they just can not get the weight off.
There are many reasons for this and in this post I will explore 4 secrets to weight loss that new research has revealed.
The old model of your metabolism and hormone levels, alone, being the reasons for success or failure of your weight problems is proving to be outdated.
In the old model, the primary reasons for difficulty with weight loss are: eating too much, or eating too much food laced with sugar, fat and salt ( this is a still a real problem for many). In addition, a lack of exercise and hormone related problems like not enough thyroid hormone or excess cortisol.
While these are very real issues and should be considered in any weight related treatment, they have been shown to not be the answer for many women (and men ) with Hashimoto’s struggling with their weight.
I recently attended a seminar taught by Dr. Datis Kharrazian, one of the world’s leading experts on the treatment of thyroid issues with functional medicine, called The Neuroendocrine Immunology of Exercise and he taught us about this new research that has discovered an entirely new model of causes for stubborn weight gain.
This model involves causes of weight problems that are related to the immune system. And this makes sense for people with Hashimoto’s because it is an autoimmune disease and a thyroid disorder.
If blood tests show that your TSH and T4 levels are “normal”, you are eating well and exercising and you still can’t lose weight, then this may be exactly what is going on with you.
According to Dr. Kharrazian, in the immune system model, there are 4 main reasons for stubborn weight gain.
They are:
* The mix of bacteria in your gut
* Intestinal permeability (also known as leaky gut)
* Low grade inflammation
* Immune reactive dietary proteins
Let’s explore each one of these in more detail.
An important thing to understand is that your body is an ecosystem, or really, a lot of interconnected ecosystems. And the digestive tract is one of the most complex and dynamic of them all.
Each one of us has their own unique mix of bacteria and other organisms that live in our guts. This mix is determined by our genetic profile, our diets, what medications we have taken and our environment.
There are an estimated 100 trillion different cells and over 1,000 different species of bacteria. 90% of these species belong to 2 families: Firmicutes and Bacteriodetes.
New research has shown that the balance of these 2 bacterial species matters for whether or not you are able to lose weight.
In obese and overweight people, there is more Firmicutes than Bacteriodetes. The balance between these 2 species of bacteria generates certain signals to specific genes in the intestines that produce more fat cells.
It is also interesting to note that, according to the research, Lactobacillus bacteria (the most common species sold in over the counter probiotics) actually increases body weight. Both dairy and non-dairy sources.
What that means is that while probiotics may be beneficial for the ecosystem of your gut they are not that helpful in helping you shed the pounds.
Firmicutes really like junk food. To feed them and gain weight, eat like your average American. To starve them and lose weight, read on.
The more important question is: how do you increase the Bacteriodetes? It seems these little critters really like plants. And the best way to increase their number is to increase the amount of plant based foods and fiber in your diet.
Especially oligosaccharides (found in Jerulsalem artichokes, and onions, leeks, garlic asparagus and jicama, etc.) and monosaccharides (found in pears, grapes, peaches, apples, pineapples, apricots, bananas, yams, carrots, onions, and sweet potatoes). And other plant based fibers that come from green leafy vegetables, green tea, etc.
These get fermented in the colon by the good guys and help you to become a mean, lean weight loss machine! But, just so you know, this is not something you can change in 5 minutes or 5 days. It may take a few months to alter this environment.
While it is true that people with Hashimoto’s often suffer from intestinal permeability or leaky gut syndrome, new research shows that this can also lead to fat around the organs.
In leaky gut, the intestines lose their ability to keep tiny particles of all sorts of stuff out of the bloodstream. It turns out that there may be a connection between a fatty liver and the breakdown of the gut barrier system.
In addition, zonulin, a protein that is used by the intestines to bind tight junctions, leaks into the blood stream when people have a breakdown of this barrier. It is also increased with obesity associated insulin resistance.
Finally, the toxins that are produced by bacteria known as lipopolysaccharides have also been linked to obesity and the onset of diabetes.
Bottom line: If you want a smaller gut, you need to heal your leaky gut.
Autoimmune disease is a disease that is closely linked to inflammation. So is type 2 diabetes, so is eating a lousy diet and eating too much sugar, salt and fat.
What research is now showing us, is that obesity is also an inflammatory condition. It is becoming less clear which came first. One thing we now know is that adipose tissue (fat tissue) produces inflammation in the body all by itself.
So you have the creation of this destructive cycle of abnormal gut bacteria and leaky gut leading to a process (insulin and leptin resistance) which makes glucose not able to enter cells. When glucose can’t enter cells it gets converted into fat in the liver (triglycerides). These fat cells start the whole process all over again.
Leptin is one of the main hormones involved in hunger, metabolism and the control of how energy from carbs and fats get stored and used. It comes from the Greek word ‘leptos’ meaning thin.
The amount of leptin produced directly correlates with weight loss or weight gain. (Women have significantly higher circulating leptin than men).
Leptin resistance is very similar to insulin resistance. With insulin resistance, long term elevated levels of insulin make your muscle and fat cells more resistance to the action of insulin.
Chronic elevated levels of leptin end up making you eat way too much. And abnormal gut bacteria and leaky gut feed this process as well (pun intended ;)).
This whole process creates more fat tissue which causes more inflammation, and on and on it goes, snow balling and making it harder and harder to lose weight.
So you can see, while this is kind of complicated, it is hugely important to do everything you can to reduce inflammation that is the root cause of everything that we have just examined.
Certain proteins can also add gasoline to the flames of inflammation.
Everything that is living in our world is made of proteins. With autoimmune disease the immune system confuses our own proteins with that of an invader like a virus or a food we are allergic to.
There are some proteins in our diet that can cause an immune response that can also lead to inflammation and add more insult to injury.
These proteins are found in gluten, dairy and soy and in some other foods called cross reactors. You can learn more about them in this post.
These need to be eliminated from the diet if you want to lose weight because this will begin to unwind the vicious cycle of inflammation at the root of the immune system’s influence on weight gain.
Bye bye inflammation, bye bye weight.
Have you had trouble losing the pounds even though your lab test numbers look “normal”?
Do you eat well and exercise, but still can’t lose the pounds?
Do you experience the common symptoms of inflammation like brain fog (inflammation of the brain), joint pain (inflammation of the joints), thyroid nodules (inflammation of the thyroid) and weight gain (body wide inflammation).
Need help? Schedule a 30 minute Hashimoto’s Healing Discovery Session: Click here to set up a time to chat.
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Diabetes. 2007 Jul; 56(7): 1762-1772. Metabolic endotoxemia initiates obesity and insulin resistaence.
Hashimoto’s is one of the most common autoimmune diseases in the US. It is routinely undiagnosed or under-diagnosed and when it is treated, the gold standard of treatment is to give patients Synthroid or Levothyroxine (Synthetic T4).
To monitor whether or not this is working most doctors periodically test TSH.
This approach often does not work and, more importantly, millions of women and men with Hashimoto’s who are being treated this way do not feel any better, or feel better for a period of time, then end up feeling really lousy.
They wind up feeling all the symptoms of hypothyroidism like being tired all the time, they can’t lose weight, they have lots of joint and muscle pain, they suffer from brain fog, anxiety and depression, their hair falls out, they feel cold, they have no sex drive and their lives become miserable.
And many of them have blood test results that look normal.
In this post I will examine why TSH is not a good measure of whether or not thyroid hormone is absorbed by the cells of the body and discuss some better alternatives to testing, supplementation and monitoring of whether or not a given approach is working.
How Does Thyroid Hormone Work in The Body?
Before we look at how most people are treated, it’s important to understand how thyroid hormone works in the body.
TSH is thyroid stimulating hormone. This is released by the pituitary gland to stimulate the thyroid so that more thyroid peroxidase (an enzyme) is made. This enzyme combines with iodine to make thyroid hormone, T4 and T3. About 97% is T4 and 3% is T3.
The body can’t really use T4, so it has to convert this into T3 which is the form that the cells of the body can use to do stuff. 60% of T4 is converted by cells in the liver, another 20% by cells in the gut and the remaining 20 or so % is converted by cells in the peripheral tissues of the body (muscles, fat, etc.)
Why Is Synthroid (Levothyroxine) Sold As The Answer?
Because most of the hormone that is made in the thyroid is T4, the logic is that for those with Hashimoto’s (an autoimmune disease that slowly destroys the thyroid) and hypothyroidism (low thyroid activity) giving a synthetic form of T4 such as Synthroid or Levothyroxine will replace what the body is not doing for itself.
Then, theoretically, the rest of the process will happen as it should – the liver will do it’s thing, the gut will do it’s thing, and the rest of the peripheral tissues will do what they are supposed to do.
Oh, if it were only as simple as that!
Many Things Hinder the Conversion of T4 to T3
There are many, many factors that can cause problems all along the way in getting this synthetic hormone into a form that the body can use and, getting the tissues of the body to effectively absorb it.
And for millions of people, this process just does not work. This is because there are so many things that disrupt thyroid hormone’s ability get into cells, these include: dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, high cholesterol and triglycerides, chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and aging.
(Here’s a really interesting graph that shows how this works.)
Testing TSH, T3 and T4 Doesn’t Measure Thyroid Hormone In The Cells
What most doctors learn in medical school is that testing TSH and total T3 and total T4 will tell you how the thyroid is functioning or how well thyroid hormone replacement is working.
This is just not true. This false idea is based on assumptions about how thyroid hormone gets into the cells of the body. In the old, out dated theory, it is thought that thyroid hormone simples diffuses or is absorbed like soda from a straw into the hungry mouths of eager cells.
More recent research has shown that its not diffusion at all, but rather active transport that requires energy from the cells to get the hormone in. What this means is that anything that compromises energy production in the cells (mitochondria make energy in the cell – so things that mess with the mitochondria) will cause less thyroid hormones to get into cells.
These include all of the list of conditions mentioned above and stress is one of the most profound blockers of this process.
In addition, the different thyroid hormones require different amounts of energy to get into the cells. For example, T4 takes more energy to get into cells than T3. (This is why many people do better on T3 only supplementation or combinations of hormones that combine T3 and T4.)
So if you have any or some combination of these conditions: dieting, anxiety, stress, insulin resistance, obesity, diabetes, depression and bipolar disorder, high cholesterol and triglycerides, chronic fatigue syndrome, fibromyalgia, neurodegenerative diseases (Alzheimer’s, Parkinson’s and multiple sclerosis), migraines, cardiomyopathy, and/or aging, and you are taking T4 only, you are going to have a very hard time getting that into the cells of your body.
Almost Everybody Has This Problem
That pretty much covers most of the population on thyroid replacement hormones.
This is important because T4 has to get into cells to be converted. What’s also interesting is that measuring serum T4 (T4 in the blood) won’t tell you anything about how much of it is getting into the cells. Instead, you have to measure Reverse T3 and free T3 levels and measure their ratio. (More on this in a moment).
This is also why some people have normal numbers but still have lots of hypothyroid symptoms (fatigue, hair loss, joint pain, brain fog, constipation, depression, low libido, etc.) even though their lab results are normal.
They have low T4 levels in their cells and more in their serum. So everything looks hunky dory, but they feel terrible. TSH testing will not pick up this problem because TSH is produced in the pituitary and this gland absorbs thyroid hormone very differently than the rest of the body.
The Pituitary Not the Thyroid Determines TSH Levels
The pituitary is much more sensitive to thyroid hormones and transports thyroid hormone differently than all other cells in the body.
In the pituitary, thyroid hormone does not depend on energy to get into the cells. The transporters for T4 and T3 in the pituitary are also not inhibited by numerous environmental toxins and substances produced by the body during physiologic stress and dieting, things that inhibit thyroid transport into other cells in the body, including bilirubin and fatty acids.
In other words, all of the stuff that prevents the cells in the rest of the body, do not affect the absorption of T3 and T4 in the pituitary. So TSH does not reflect the hypothyroid state in the rest of the body and is really only a good measure of thyroid hormone IN THE PITUITARY.
Thyroid hormone is absorbed into the cells of the liver differently than it is by the cells of the pituitary. This is really important to understand and most doctors and endocrinologists do not know this. Since 60% of T4 is converted in the liver, this makes a huge difference.
Why Dieting Can Make Thyroid Hormone Less Available
Many overweight people with Hashimoto’s try to lose weight and are just not able to. This has lead to a huge industry of weight loss drugs, products and procedures.
But what many people do not understand is that the reason that weight loss may be so difficult for these people is that the very process of trying to lose weight may be preventing them from being able to absorb thyroid hormone into their cells.
This creates a vicious cycle of dieting, yo-yo weight loss and gain and miserable results. And all those things actually create a state of a slower, more sluggish metabolism that all but dooms them to failure.
If thyroid hormone is not being absorbed by the cells, then you have a state of cellular hypothyroidism and your body slows down and does not lose weight. And this state of poor cellular absorption of thyroid hormone is not seen in laboratory results unless free T3 and Reverse T3 levels are done.
A very interesting study published in the American Journal of Physiology-Endocrinology and Metabolism, Van der Heyden et al studied the effect of dieting on the transport of T4 and T3 into the cell.
It was found that dieting obese individuals had a 50% reduction of T4 into the cell and a 25% reduction of T3 into the cell due to less energy in their cells, showing that in such patients standard thyroid blood tests are not good indicators of thyroid hormone levels inside the cells.
This also demonstrates why it is very difficult for obese patients to lose weight; as calories are decreased, metabolism drops.
This will, however, not be detected by standard TSH, T4 and T3 testing. In addition, there are increased levels of free fatty acids in the blood with chronic dieting, which further suppresses T4 absorption into the cells and this causes more cellular hypothyroidism.
How You Feel Is More Important Than What Your Lab Tests Say
Another interesting study published in the Journal of Clinical Endocrinology and Metabolism, by Zulewski et al clearly shows that TSH is not a useful measure of proper thyroid replacement because there was no connection between TSH and tissue thyroid levels.
Levels of T3 and T4 were better, and T3 was the best indicator. However, a thorough assessment of how patients felt determined by how many signs and symptoms of hypothyroidism they had (i.e. weight gain, fatigue, hair loss, depression, low libido, brain fog, etc.) was shown to be the most accurate method to determine proper thyroid hormone replacement dosage.
How you feel is a lot more important than what your TSH test results say.
This Is Why You Are So Tired All The Time
What all of this means is that people with Hashimoto’s and hypothyroidism who are on T4 only thyroid replacement hormone feel tired all the time, are losing their hair, can’t lose weight, etc. and just generally feel like crap because this hormone is not getting into the cells of their body.
When thyroid hormone doesn’t get into the body’s cells, it can’t do its job.
There Is Another Way
It doesn’t have to be this way. You can change this by, first, testing appropriately to see how well your cells are absorbing thyroid hormone and then by making changes in your diet, lifestyle and medications (if necessary) to make sure that you are converting and absorbing enough thyroid hormone for it to work in your body.
The proper way to test whether of not your cells are absorbing thyroid hormone is to order free T3 (fT3) and/or T3 and reverse T3 (rT3). And then to measure their ratio: the proper ratio of free T3 to reverse T3 is greater than 20. The proper ratio of T3 to reverse T3 is greater than 10.
If your numbers demonstrate that you have high reverse T3 and a low ratio, then you are not absorbing thyroid hormone into the cells of your body.
The next step is to improve the function of the areas that convert thyroid hormone and to clean up your diet and alter your lifestyle to support proper absorption of thyroid hormone.
Since 60% of T4 is converted into T3 in the liver is vitally important to make sure that you improve liver function and make sure that your liver is working properly. A good liver detox and changes in diet can accomplish this.
The next step is to clean up your gut and make sure that you don’t have intestinal problems or inflammation of the intestines that can slow or prevent proper absorption and conversion of thyroid hormone.
Next, you need to supplement and gradually heal the body so that the many conditions that can slow or stop absorption of thyroid hormone are reversed and make sure the cells of your body have enough energy to get thyroid hormone into your cells.
Lastly, you may need to start taking T3 or try a thyroid hormone that contains both T4 and T3. This will insure that enough T3 is getting into the cells of your body.
30 Minute Confidential Telephone Consultation
I am offering a 30 minute telephone consultation if you would like to learn more and discover whether or not you have issues that may be preventing your cells from absorbing thyroid hormone.
Click on this link to schedule the consultation.
Its Not Easy, But The Results Can Be Dramatic
This is not a simple process and you need to work with someone who understands how to guide you through this process.
That’s why I have created a simple 60 day program that can dramatically improve the way the cells of your body absorb thyroid hormone:
This program includes:
* Free T3 (fT3) and reverse T3 (rT3) testing
* A 30 day liver detox program
* A 30 day gut healing program that incorporates the Hashimoto’s Diet Plan
* Supplementation and guidance to improve cellular energy production.
* Follow Up testing
Click on this link to schedule a confidential 30 minute consultation.
References:
http://nahypothyroidism.org/thyroid-hormone-transport/
http://nahypothyroidism.org/files/thyroid_transport_graph_3.pdf
http://www.stopthethyroidmadness.com/rt3-ratio/
Zulewski H, Muller B, Exer P, et al. Estimation of tissue hypothyrodisim by a new clinical score: Evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82(3):771-776.
Kharrazian, Datis, DC, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? 2010, Elephant Printing
Hashimoto’s is one of the most common autoimmune disease in the United States, yet is is also one of the most poorly managed. One of the most common questions I get is, what tests should I ask my doctor to order?
Because Hashimoto’s is a thyroid disorder and an autoimmune disease there are a number of additional lab tests that are important but are not, specifically, tests for the thyroid. In this post I will discuss them all and explain why it is important to order them, as well.
There are some people out there on the internet, who, out of frustration, believe that you should forget about asking a doctor to order tests for you and just order them for yourself.
In their defense, many doctors do not order the appropriate tests to do proper management of thyroid patients. There is too much emphasis put on some tests, and not enough on others that can give a great deal of information about how you are doing and how your medication is working.
However, here’s my take on that:
If you bought a luxury car, say a Tesla or a Lamborghini, you’d want to make sure it was kept in tip top shape. Would you do the diagnostics yourself? Think about how long it would take you to master the proper care of those vehicles.
It’s kind of the same thing with your body and lab testing. Hashimoto’s has so many moving parts. You are better off finding a doctor who you can have a partnership with who can give you his years of clinical expertise and help you to make sense of it all.
And if your doctor can’t or won’t do that? Well, find a doctor who will and work together to do a proper history, evaluation and diagnostic testing so that you can optimize your body and your health.
For myself, my health and my body are worth way more than a luxury car. I want to do everything I can to make sure it is kept in the best possible running order. And ordering your own lab tests can be very expensive, especially if you don’t have insurance. I give my patients lab tests at my cost. We can get them at a substantial discount and we are able to pass the savings onto them.
When interpreting Hashimoto’s lab tests you are always given 2 sets of numbers. Your test results and the laboratory range. The laboratory range is an average that is calculated based on the number of people who go to the lab in a given geographic area for a fixed amount of time.
These averages are influenced by many things: the health of that general population, the medication that is popular and prescribed during that period of time and by what general diseases those people have.
All of these factors skew the numbers. Have you been to a lab lately in your area? Spend a day there and ask yourself if those people represent the quality of life and general state of health that you want.
In many areas, in the US in particular, the general population has not gotten any healthier over the last 20 years. Look at the statistics. You probably don’t want to be among that average group. What I am getting at is, the laboratory range is not really a measure of good health. This is particularly true when it comes to the thyroid.
Millions and millions of Americans have thyroid disease and are on thyroid medication. This skews the numbers. Practitioners of functional medicine, like myself, use an additional set of numbers when we evaluate people’s health.
This is called the functional range and different specialists in various fields have identified these ranges as being where optimal health is.
So, when you are looking at laboratory results make sure you ask about functional ranges as well as laboratory ranges. Many doctors do not look at functional ranges, so be aware that asking about this may elicit a confused or dismissive response. (In this post we are focusing on lab tests alone, in a future post I will discuss how to interpret these tests.)
Hashimoto’s is an autoimmune disease and a thyroid disorder, so we must evaluate many things not just the thyroid. Here’s a list of what any good workup should include:
* Thyroid tests: TSH, free T3 (fT3), free T4 (fT4), Reverse T3, (rT3)
* Blood Sugar Analysis: Fasting glucose, HgA1C, Triglycerides, Cholesterol, LDL, and HDL
* Iron: Serum iron, TIBC, Transferrin and Ferritin
* Vitamin D3
* Vitamin B12 and B6
* Red and White Blood Cell Count: Complete CBC
* Tests to determine Adrenal Gland Health: BUN, Creatinine, Sodium and Potassium, Special test(s)
* Electrolytes: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous
* Markers that Evaluate the Health of the Intestines: Protein and Globulin, Special tests
* Hormone Testing: Saliva tests
* Immune Cell Testing: Special tests
…and maybe more, depending on what is found in a good thorough history. Let’s take a look at each of these briefly to give you a good sense of what we are looking for.
Thyroid Testing
TSH – Thyroid stimulating hormone (TSH), also called thyrotropin is released by the pituitary gland after the hypothalamus releases TRH (thyrotropin releasing hormone). TSH is the most common and most sensitive marker used to assess thyroid function. But it is not the be all and end all in thyroid testing, the way that so many doctors and practitioners make it.
In addition, many laboratories have do what is called a “thyroid cascade” in order to save themselves and insurance companies money. Basically, if the TSH is deemed to be in the normal range they will not analyze for T3 or T4 or anything else. That doesn’t help you and there not much agreement on what the normal range should be.
TSH levels increase as T4 levels drop and TSH levels decrease as T4 levels rise. The reason this is the most popular test in today’s medical model is because the only treatment offered for thyroid dysfunction is thyroid hormone replacement and that’s what doctors are checking when they test your TSH.
A TSH test alone doesn’t give you information about thyroid-pituitary communication, about T3 to T4 conversion in other parts of the body or about whether or not your immune system is attacking your thyroid.
One important thing for Hashimoto’s people to understand is that some antibodies can inhibit thyroid function by turning off instead of stimulating TSH receptors on cells. In this case, you will see high TSH and high antibodies.
Free T3 – measures the free T3 hormone levels. This test is rarely ordered by traditional endocrinologists and is usually only used when a patient has hyperthyroid symptoms and the fT4 levels are normal.
Even so, this test can be really useful for finding out what amount of active thyroid hormones are available for the thyroid receptor sites. Free T3 is high in hyperthyroid conditions and low in hypothyroid conditions. May also be high in thyroid toxicosis.
Free T4 – used to measure the amount of free or active T4 in the blood. High with hyperthyroidism, low with hypothyroidism. The drug Heparin can also cause elevated free T4 as can some acute illness. Its also high in an overdose of thyroid hormone.
Reverse T3 – Reverse T3 is usually produced when there is an extreme amount of stress. For example, a serious car accident, or surgery or really bad chronic stress.
Its no surprise that this is elevated after a stress response or when the body produces high amounts of the stress hormone cortisol. Reverse T3 is low when you have severe tissue damage like a bad burn or laceration or when you have liver disease like cirrhosis.
This may also be high if your iron is low.
Thyroid Antibodies
When these antibodies are present, it means that your immune system is attacking your own tissue. When your body produces thyroid autoantibodies it could create a hypo- or hyper- thyroid state.
They may also be elevated if there is thyroid cancer. Some antibodies can attach to TSH receptors, but they don’t cause a response in the thyroid.
These people will complain of low thyroid symptoms, but the TSH might not change at all. In other cases, the antibodies bind to receptor sites and cause the thyroid to be over active. Here you will see high T4, low TSH and high antibodies.
There are 3 autoantibodies that are tested. The first 2 are the most common:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
Thyroid-Stimulating Hormone Receptor Antibody (TRAb): This antibody is only ordered when a patient is hyperthyroid. Positive results usually mean Grave’s disease.
For a complete overview of all thyroid tests to order, you can read my previous post here.
Blood Sugar
Measuring blood sugar is critically important for Hashimoto’s patients because if you have issues with your blood sugar (too high or too low) it can undermine everything else you are trying to do.
Fasting Glucose: A snapshot of how your blood sugar is at the time of the test.
HbA1C (Hemaglobin A1C): This test is a long term sugar marker and commonly used to assess type II diabetes and metabolic syndrome. (It’s optional, but should be ordered if you are overweight and have a history of high triglycerides and fat around your waist.)
Triglycerides: These are sugars stored in the fat in the liver.
Cholesterol, LDL, HDL: Most people have been brainwashed into thinking cholesterol is about fat. Don’t be misled. Its about sugar and sugar consumption and statin drugs do nothing to fix this.
Iron:
Iron is another “deal breaker”. If you have low iron it will undermine everything you are trying to do and make it unsuccessful. Hashimoto’s folks, especially women, often have issues with their iron levels. Most iron panels contain all of the following tests:
Serum Iron – Iron is necessary for making hemoglobin which carries oxygen on red blood cells. Decreased iron levels must be correlated with RBC, HGB, and HCT to rule out anemia (more on what those mean in a moment).
TIBC – Total iron binding capacity. this will be elevated in iron deficiency because this increases the cells’ potential to bind to iron. TIBC is high before anemia develops and, therefore, can be a good way to find iron deficiency early.
Transferrin – Regulates iron absorption. Increased with iron anemia.
Ferritin – A good marker for total body iron levels and reflects how much iron the body has stored. It also called an “acute phase reactant” and can be a good marker of inflammation.
Vitamin D:
Test for Vitamin D3 (25-hydroxyvitamin D). Vitamin D is hugely important for people with Hashimoto’s because it strengthens the regulatory part of the immune system and we often have difficulty absorbing it.
Vitamin B12, B6 and Folate
These tests can be expensive and B12 and B6 can be tested by reading a CBC (Complete Blood Count) properly, a test that is available for under $20. (I’ll explain how to do this in a future post.)
CBC
A complete blood count that includes: Red Blood Cell counts: Red Blood Cells (RBC), Hemoglobin (HGb), Hematcrit (HCT), MCV, MCH, MCHC
and White Blood cell counts: White Blood Cell Count (WBC), Lymphocytes, Neutrophils, Basophils, Monocytes, Eosinophils.
There is a ton of information that you can gather from this very inexpensive test, including information about various anemias, autoimmunity, and possible infections that may be affecting your progress. (More on how to interpret this in a future post).
Electrolytes: These tests are usually part of what is called a “metabolic panel” and can be helpful in finding mineral deficiencies and electrolyte imbalances. These include: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous. The metabolic panel will also include Serum Protein, Albumin and Globulin.
Adrenal Health:
On a simple blood test, you can test the adrenals by ordering a Renal panel (BUN, Uric Acid, Creatinine) and by evaluating electrolytes, Potassium and Sodium.
The gold standard for measuring adrenal health is a saliva test that tests cortisol levels throughout the day. This can tell you a lot about how adversely stress may be affecting your health and your thyroid.
Special Tests:
These are all tests that can be very important for Hashimoto’s patients, but they are complicated and should be ordered by someone who knows what to do with the information that they provide.
Intestinal Health:
Healing the intestines is job #1 for many Hashimoto’s patients because the gut is where the immune system lives and if you want to modulate and calm your immune system, you must go there it lives. In a common blood test, Serum protein, and globulin levels can give clues to intestinal issues.
There are test on the market for intestinal permeability (leaky gut), gluten sensitivity and intolerance, and cross reactive foods that may be causing immune flare ups. The best Lab for this is Cyrex labs.
Hormone Testing:
There are various hormones that can be tested including, estrogen, progesterone and testosterone. This is involved and deserves a blog post of its own (which I will, humbly provide, in due time).
Depending on what you want to accomplish, the best of these to determine fertility and possible defects throughout a woman’s cycle are saliva tests gathered at intervals throughout the entire month.
Immune System Testing:
There are various ways to test the different aspects of the immune system from Cytokine testing, to TH-1 and TH-2 challenges. This is also quite complicated and involved and must be done with someone who understands what to do with this data.
Bottom Line:
As you can see, this can get pretty complicated, pretty quick. The best thing to do is inform yourself and then work with someone who is experienced in reading and evaluating these kinds of tests and who knows what to do with the data that is gathered.
That is what I offer here at Hashimotoshealing.com and why I created my program, Healing Hashimoto’s: the 5 Elements of Thyroid Health. In this 6 week intensive you will learn how to interpret your blood tests and, more importantly, learn what to do with that information in order to create an effective strategy for Healing your Hashimoto’s.
Hashimoto’s is the most common autoimmune disease in the United States. It is a thyroid disorder and an autoimmune disease. The autoimmune part of the equation makes virtually everything a challenge and this is particularly true when it comes to trying to figure out what to eat.
One of the absolute truths about Hashimoto’s is that no 2 people have the same version of the disease. There are too many variables, people are at different stages of progression, and they have other autoimmune, endocrine, digestive or systemic problems.
So, generalizing about what kind of diet is the best is kind of like asking, “Where do I build my house on this minefield?”
You build it where it won’t set off the mines. Some people estimate that 70 – 80% of the immune system is found in the gut.
Whatever the actual percentage, there is no doubt that what goes through your digestive system has a huge impact on your immune system. Huge.
This concept is just common sense, but many doctors and health care practitioners ignore it. Why? One doctor friend of mine put it to me this way.
He said, “I don’t bother trying to change people’s diets. It’s easier to get an alcoholic to stop drinking than to get people to change the way they eat.”
People are attached to food. It has cultural, emotional and psychological roots that run deep. However, if you have Hashimoto’s and you want to learn to manage it properly, you need to abandon all of that. It will not serve you.
Many people with Hashimoto’s also have intestinal permeability, also known as leaky gut. A healthy GI tract is one that one has a lush forrest of villi, all held tightly together.
This keeps the bad guys, like bacteria, chemicals, environmental toxins and undigested food out of the blood stream. Unfortunately, chronic inflammation turns this lush forrest into a desert and poor diet, blood sugar imbalances and chronic stress open up wide chasms that a molecular 18 wheeler could drive through.
Many people believe that this actually sets the stage for the onset of autoimmune disease when the immune system shorts circuits and starts confusing other stuff with our own tissue. The one food that is most often implicated in this is gluten.
Many people also believe that the best way to heal autoimmune disease is by healing the gut. ( I am one of those people. ) So this begs the question, what heals the gut?
The first step to healing the GI tract is to remove all the foods that are creating chronic immune responses. Eventually, you can add them back in one at a time (hopefully). When you do you will begin to discover your own unique set of land mines.
And instead of rummaging around in the dark there are now also diagnostic tests available to help determine which foods cause an autoimmune response in you (More on this in a moment). This can save you a lot of trial and error and can help you identify the really bad ones.
The foods that tend to be the worst are those that you, invariably, love the most. Like ice cream, cheese, bread, and pasta. And there is a biological reason for this. Both foods made from gluten and milk have proteins that are very similar in structure to morphine.
They are called casomorphin in milk and gluteomorphin or gliadorphin in wheat products. Now wonder we love them, we’re freakin’ addicted to them!
There are a few different camps out there for autoimmune disease diets. Most of them involve elimination and provocation. In other words, you take foods out and put foods back. The biggest differences seem to be which foods you put back.
Once again, the reality is that some people can put some foods back and others can’t. Remember, your Hashimoto’s is not your brother’s or sister’s Hashimoto’s. You have to find your own way. There are some foods that some people will have to eliminate from their diets forever. FOREVER.
And this is the real challenge. Because some people will suffer more from cheating than others. But, even if you feel like the damage wasn’t so bad and you can live with it, it may be destroying valuable tissue like your brain or something that you might want to use later in life.
Cheating can have serious and, sometimes, silent consequences, like the destruction of important tissue.
Here’s a quick overview of the most popular diets currently being used.
The Paleo diet or Paleolithic diet, also called the Cave man diet or Hunter-Gatherer diet, is one in which you are told to eat like our nomadic ancestors. Centered around common modern foods, this diet consists mainly of fish, grass-fed pasture raised meats, eggs, vegetables, fruit, fungi, roots, and nuts, and excludes grains, legumes, dairy products, potatoes, refined salt, refined sugar, and processed oils.
Critics argue that this diet is essentially just the Atkins diet with a few updates, but it has a loyal following. And if you really ate like our Paleolithic brethren, that is, you hunted around the African plains with a spear and a few rocks, you would eat a diet that was largely plant based with a few lucky days of meat binging thrown in.
And you would spend a lot of time running and doing old school cross fit maneuvers as you escaped hungry lions and hyenas. Definitely a formula for good health – if you didn’t get eaten.
The autoimmune version of this diet removes grains, eggs, beans, legumes, dairy, soy, refined sugar and salt, all processed oils and nut based oils, and night shades (tomatoes, eggplants, peppers and potatoes) and, sometimes, nuts.
Its really restrictive, but can be quite effective. The real issue seems to be – can you come up with a diet plan that isn’t basically all meat all the time? And you definitely can. You need to make a conscious effort to have plenty of fruit and vegetables.
Some people with Hashimoto’s do very well on this diet and it can dramatically improve the health of your gut on its own. Add some supplements that heal the intestines, as well, and you could have a winning formula. (More on that in an upcoming post)
The flip side of Paleo is the Vegan autoimmune diet. It is, essentially a gluten and, in some cases, grain free vegan diet. No meat, no dairy, no eggs, no animals, and no fish. And in some cases, no grains or beans.
Critics of this diet argue that you don’t get enough amino acids from plants alone and many Hashimoto’s folks are also iron, B12 and Vitamin D deficient and its hard to virtually impossible to effectively keep those levels up without animal products or supplementation.
It also takes a lot of things, pardon the pun, off the table. So it doesn’t leave you a lot left to eat.
But this diet also has its loyal fans and can be very effective in reducing the inflammation that drives the autoimmune process and destruction of the gut. If supplements are added here, and you eat enough, you can also have a winning formula with this approach.
Some people think that one way to figure out which version of the autoimmune diet is best for you might be to use blood typing. Those with blood types that need meat (Type O) might do better on Paleo, those who are not big meat eaters (Type A) may do better with the Vegan version.
The remaining blood types (B and AB) might need some hybrid of the two. Which ever you chose it is vitally important to eat as much variety as you can within all these restrictions and to supplement with iron, Vitamin B12 and Vitamin D as it becomes necessary.
All of these autoimmune diets remove lectins. Lectins are nature’s answer to insects long before Monsanto began its evil march towards domination of our food supply.
They are, basically, natural pesticides that live in plants to help them survive the ravages of fungi, bacteria and viruses. They are kind of like natural toxins.
Lectins are carb binding proteins that protect plants and have other functions like protein synthesis and delivery in animals. They’re pretty sticky molecules, which makes them cause problems in our intestines because they get stuck there and start eating away at the walls.
It is believed that lectins leave leaky gut in their wake, in a trail of savaged villi. Once they have wrought their carnage, they breach the walls of the intestines and leak into the bloodstream with lots of other unwanted particles. And the immune system goes nuts trying to deal with it all.
Foods with the highest amounts of lectins are: grains of all kinds (wheat being the worst), legumes (soy being the worst), nightshades (mentioned earlier), and oils made from seeds. GMO foods also have lots of lectins because they are used in genetic modification to enhance pest and fungal resistance.
Salt: Recent studies have indicated that that high salt levels may push the initiation of autoimmunity by driving the TH-17 pathways. Basically, its an on switch.
Problem. Lots of Hashimoto’s people have low blood pressure and desperately need salt. Iodine can also be bad for some Hashimoto’s people. Answer: Moderate salt without iodine (unless you are iodine deficient – there’s always a caveat).
Sugar Issues: Many Hashimoto’s people have blood sugar issues and if their blood sugar goes too high or too low it can really impede their progress. Some of these diets are so restrictive that people’s blood sugars end up dropping and spiking and they wind up defeating the very program that they are on.
Answer: Find the foods you like, eat them often. Start the day with a protein. Don’t ever skip meals.
Anemia: Many Hashimoto’s patients develop anemia for a host of reasons. This can completely undermine any dietary changes you are trying to make. Test for iron deficiency and red blood cell counts and make sure you are supplementing with iron if necessary (especially if you are choosing the vegan route). Vitamin C can also enhance iron absorption.
Cross Reactors: These are foods that have a similar protein structure to gluten and our own tissue. Like gluten, they may have to permanently avoided because they drive the autoimmune attack and disease progression.
Parasites, Candida and Other Critters: Some people with Hashimoto’s may also also require additional treatment of the ecosystem of their intestines. These can further complicate dietary restrictions and supplementation.
Adrenal Issues: The adrenals play a critical role in intestinal permeability and with insulin resistance. Cortisol causes the intestinal walls to open further and it makes insulin not work a well. So stress management and adrenal love are also really important.
Other Autoimmune Diseases: Many Hashimoto’s people have other autoimmune diseases in various stages of progression and some of these can have a huge impact on the digestive system, such as Type I diabetes, adrenal autoimmunity, liver autoimmune, Crohn’s disease and more. If these factors are present, adjustments must be made accordingly.
And this is just an overview to give you a sense of the complexity, difficulty and variability of what you are dealing with. There are many more issues that can come into play and undermine your progress. These include, the gall bladder, neurotransmitters and the brain, low stomach acid and more!
There is some terrific diagnostic testing available today that can help to decipher some of these puzzles. We can test for intestinal permeability, cross reactors, additional autoimmune issues, etc. These tests are not that expensive if your doctor won’t order them or doesn’t know that they exist.
Diet is critically important in the successful treatment of Hashimoto’s, but a diet that works for someone else may not work for you. You need a program that is tailor made for your unique set of circumstances and related issues.
Need help? I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
http://www.biomedcentral.com/1472-6823/5/10
http://www.marksdailyapple.com/lectins/#axzz2O1CpwpQ5
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115659/
Prevalence of celiac disease in autoimmune thyroiditis. Minerva Endocrinol 2007 Dec;32(4):239-43
Celiac disease and autoimmune thyroid disease. Clin Med Res 2007 Oct;5(3):184-92. Review
Interleukin 18; An Immune Protein That Causes Inflammation in Hashimoto’s
Hashimoto’s is the most common autoimmune disease in the United States, but very few doctors, alternative practitioners or patients understand what is happening to the immune system or what to do about it.
As a result, treatment largely ignores the autoimmune part of the disease. In this post, I break down the basics of the immune system, explain how it affects people with Hashimoto’s and why it matters.
The immune system protects us from foreign invaders. Its like our body’s military. It finds the bad guys (like bacteria, fungus, parasites and viruses) and it kills them. It also cleans things up by destroying our own dead and dying cells. This is called cellular apoptosis, and if this process stops working, cancer develops.
In addition, the immune system creates inflammation as part of the process of healing after an injury. Recent research has shown that immune system has the ability to communicate with the nervous system, the endocrine system and digestive system and that it is actively modulating and influencing the body all the time.
The immune system has many different parts, but the 2 important parts are called non-specific and specific immunity.
Non-Specific Immunity
The non-specific immune system is our immediate attack response. These are the front line soldiers that hang out in our borders (the mucous membranes of our lungs, digestive tract, skin and brain) and kill invaders.
This part of our immune system is called the T-Helper 1 (or TH-1) response. These are the macrophages (the Pac-man cells) and Killer T cells, the elite squads that are pathogen killing machines.
TH-1 is also broken down into messenger proteins like Interleukin-12 (IL 12), Interleukin 2 (IL-2), Interferon Gamma (IFN) and Tumor Necrosis Factor (TNF). These are the bad ass cells that get the job done.
IL-12 is a commander and facilitator that is responsible for helping cytotoxic lymphocytes, natural killer cells mature and it also supplies growth factor to help certain cells grow into the killers that they are.
It is also involved in turning on genes that result in attacks on specific organs and has been implicated as an important player in Hashimoto’s.
IL-2 is synthesized by CD 4 T cells, it increases antibody production, improves bone marrow responses to other immune cells and is used in the treatment of HIV.
A close relative of IL-2, IL-15, has been shown to be low in Hashimoto’s and treatment with levothyroxine increases IL-15 levels, as do some Chinese herbs.
Here is a perfect example of the contradictory nature of the immune system. Increasing IL-15, some theorize, may reduce the destruction of thyroid cells in Hashimoto’s.
Interferon Gamma is another commander that fights viruses and prevents their RNA from passing on genetic information, it activates the pacman cells (macrophages) to destroy organisms that get inside of cells and it kills tumor cells.
Tumor Necrosis Factor (alpha) also kills tumor cells, it turns on angiogenesis (the hallmark of malignant tumors), promotes fibroblasts and is involved in wound healing.
TNF (beta) is another commander who helps kill tumor cells, activates genes, and it helps instruct CD8 T cells, NK cells, and helper-killer T cells to induce them to fatally injure their targets.
A TNF receptor called CD95, which is responsible for cell death, has been found to be very high in patients with Hashimoto’s.
Specific Immunity
The specific immune system produces antibodies that label the bad guys. This part of the immune system is like the C.I.A., it gathers intelligence on the invaders and it labels them with an antibody. Once a foreign invader has been labeled by an antibody, its much easier for the killer cells to destroy it.
And like the C.I.A., it takes a while for them to gather the intelligence, so this process is usually delayed for a period of time. This part of the immune system is called T-Helper 2 (or TH-2).
These cells also do more than just labeling, they also attach themselves to certain cells like viruses to keep them from entering into our cells. This is important because once they are in our cells, they are much harder to kill and they can replicate more quickly.
TH-2 is also broken down into interleukins. The proteins IL-10 and IL-4 being 2 important ones.
IL-10 has been implicated in numerous autoimmune disease such as type I diabetes and multiple sclerosis. But it is another perfect example of the unpredictability of the immune system. It turns on some immune functions and shuts off others. It can block IL-1, IL-6 and TNF alpha, but turns on IL-2 and IL-4.
IL-4 is produced by CD 4 T cells and activates IgE, an immunoglobin important for creating immunity to parasites and involved in allergies.
To further complicate matters we have other parts of the immune system driving the immune attack and this is the family of interleukins that belong to IL-1. IL-1 is released by the pacman cells that are the front line attackers.
IL-18 belongs in this family of proteins and there is a lot of it in Hashimoto’s patients, especially those with severe symptoms that don’t respond to levothyroxine treatment. It may be responsible for severe inflammation.
Both parts of the immune system are needed for certain types of invaders. For example, viruses are often very small and can sneak past the border security. Then the TH-2 system uses it’s cellular informants to sniff them out and it tags them.
This can take several days to initiate and this is why it takes most people a few days to fight the common cold, which is caused by a virus.
In a general sense, the TH-1 system is considered inflammatory and the TH-2 system is considered anti-inflammatory. But in reality, they are both involved in the process of inflammation. And IL-12 and IL-18 are important drivers of inflammation in Hashimoto’s.
Recent research has shown that there are other parts of the immune system that play important roles in this process. T-Helper 3 (TH-3) cells are the regulatory part of the immune system. They help to orchestrate TH-1 and TH-2 cells and act as kind of cellular general to call off or calm the attack.
T-Helper 17 (TH-17) cells are instigators and they rev up the attack and can make the damage and the carnage much more intense. A delicate balance of all parts of the immune system is important and with an autoimmune disease, like Hashimoto’s, this balance is lost.
There are many possible reasons for the immune system to start labeling the thyroid as foreign tissue and create autoimmune thyroid conditions (including genetics, environment, endocrine imbalance, chemical exposure, responses to viruses and other antigens, stress responses and more).
It is probably some combination of those many factors that lead to the loss of self tolerance and the immune system attacking the body’s own tissue.
In most cases of Hashimoto’s, some combination of the factors mentioned above lead to a slow, gradual attack against the thyroid. This eventually leads to the loss of enough thyroid cells that the condition presents as primary hypothyroidism and is seen on a blood test as high TSH.
TSH becomes high because, when the thyroid is not working properly, the pituitary gland increases production of TSH to increase thyroid gland activity. For most people with Hashimoto’s, the thyroid never develops overactive symptoms. Over time, they develop symptoms of low thyroid function and get put on thyroid replacement hormone.
The issue of the autoimmune attack is never addressed. Instead, they are considered to be properly managed by having normalized TSH.
In a sense, these patients are having their TSH managed, but they are not managing the underlying problem. Over time, they lose more and more thyroid cells and they need more thyroid replacement hormone.
The result, for many people, is that they continue to have all the hypothyroid symptoms (like fatigue, hair loss, depression, constipation, cold hands and feet, etc.) because the root cause has been largely ignored.
Since the thyroid is being destroyed, there is less thyroid hormone production. The immune system needs thyroid hormones to modulate TH-1 and TH-2 activity, so when this happens, the immune system can short circuit.
This leads to a larger number of TH cells, and autoantibody producing B cells. These cells accumulate in the thyroid and kill thyroid cells.
There are many possible scenarios that can lead to this outcome. For example:
In his book, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal, Dr. Datis Kharrazian gives some examples of things that can cause this:
* The T suppressor cells that regulate the immune response could be too few in number, and like a weak general that has lost control of his troops, this can lead to unchecked attacks by the immune system. And tissue like the thyroid becomes a casualty.
* TH-1 has a number of different soldiers, known as interleukins. These all have specific jobs. For example, interleukin 2 (IL-2) is a messenger chemical that sends out orders for the killer cells to start killing.
Some people make too much IL-2 and this creates a frenzy of destruction that can lead to the death of the thyroid cells. Chronic viral infections can cause too much IL-2 to be made and have been linked to the development of autoimmune thyroid disease.
* TH-2 also has lots of different soldiers. Interleukin 4 (IL-4) deploys B cells. Like some rouge C.I.A. agents, these cells can go crazy and tag the wrong proteins, and destruction of thyroid tissue is the result. Parasites and food allergies can cause too much IL-4 to be made.
* Too much sugar can cause the body to rapidly release insulin. These spikes in insulin can stimulate the production of too many B cells, they start tagging too many things, and this can lead to destruction of the thyroid.
And this is just the tip of the iceberg. In reality, there are many variables and many potential reasons for the immune system to short circuit. This is what makes treatment and management so challenging. And this is also why you must have a multi-pronged approach.
In most cases of Hashimoto’s, researchers think TH-1 cells become overactive (but this is not true for everyone and is an oversimplification). It seems IL-18 and IL-12 also act together to throw a beating to the thyroid.
Look for development of drugs that inhibit these 2 interleukins. In the meantime, stay tuned to learn about herbs and foods that can accomplish that naturally!
Hashimoto’s people also often have a weak TH-3 regulatory system and their TH-2 may or may not be out of control. TH-17 is also often wound up, making the attack more intense. And none of this happens in a vacuum.
This is all taking place in the context of the body where the immune system is interacting with the endocrine system, the digestive system and the nervous system. Further complicating the task of unwinding this mess. Its no wonder patients and doctors alike get frustrated and overwhelmed.
The reality is that your Hashimoto’s is not the same as anyone else’s. You may have an overactive TH-1 system or you may not. You may also have a weak TH-2 system or you may not. TH-3 is probably weak and TH-17 is also probably revved up.
And you may have leaky gut, and/or blood sugar issues, and/or adrenal fatigue, and/or anemia, and/or some active parasite or latent viral infection. It goes on and on.
You need an individualized approach that will create a unique action plan for your unique set of circumstances.
This is why I have created my 3 month program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. In this program you will learn how to develop your own unique template for healing your Hashimoto’s and, most importantly, how to calm, balance and manage your immune system.
Here’s a video of a webinar I did called Introduction to the 5 Elements of Thyroid Health that you might enjoy.
In my next post, I will discuss how this is done and we’ll look at some real examples to see how all of these different pieces fit together.
Resources:
http://chriskresser.com/basics-of-immune-balancing-for-hashimotos
http://thyroidbook.com/blog/nitric-oxide-modulation-for-autoimmune-disease/
Drugarin D. The pattern of Th1 cytokine in autoimmune thyroiditis. Immunol Letts, 2000; 71: 73-77
Autoimmune Disease and Chinese Medicine, M.M. Van Benschoten, O.M.D. 9/13/2003
Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal, Dr. Datis Kharrazian, DHSc., DC, MS, Morgan James Publishing, 2010, page 46
Hashimoto’s is an autoimmune disease and a thyroid disease. But the autoimmune part of the disease is often poorly understood and sometimes completely ignored.
There are many reasons for this, but the result is that there is a huge void in our healthcare model for treating, managing and, even, properly understanding this condition. In this post I will explore many aspects of autoimmune disease and why it should matter to you.
There is a a global epidemic of autoimmune disease taking place right now. Its shocking how little attention it is getting. According to the American Autoimmune Related Disease Association’s current statistics: 1 out of every 12 men and 1 out of every 9 women have autoimmune disease.
This is especially shocking when you understand how autoimmune disease is defined. An autoimmune disease is officially recognized when about 70 to 90% of the target disease is destroyed. You don’t just go from 0% to 70% destruction overnight. How many people do you think have undiagnosed autoimmune disease? Millions and millions.
Why aren’t more people talking about this? Is it because its not life threatening? No. Actually, autoimmune disease is the one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age.
And the numbers are higher than other major diseases: the NIH (National Institute of Health) thinks that up to 23.5 million Americans have autoimmune disease. 9 million have cancer, 22 million have heart disease.
In the US, thyroid autoimmune disease is the most common of all autoimmune disorders, affecting 7 – 8% of the U.S. population. By some estimates, autoimmune disease accounts for approximately 90% of all hypothyroid disorders and these are mostly due to Hashimoto’s.
One thing that is important to understand about autoimmune disease is that it is incurable. The condition can go into remission, but it never goes away. Unfortunately, some healthcare practitioners and patients believe this remission is a cure.
Let me put it to you simply: Anyone who tells you that they can cure your autoimmune disease is either a liar, a con artist or they don’t understand what is going on.
To date, there is no “off switch” to the autoimmune process. Once you have crossed over into autoimmunity you can not turn back. You can learn to manage it effectively, you can calm the attack, but you can never reverse the loss of self-tolerance.
The immune system doesn’t work that way. Once something has been labeled as a bad guy by the immune system, you can’t miraculously change that.
This is true of all autoimmune diseases. We are composed of tissue made of proteins. These proteins have specific amino acid sequences. There are only a finite number of amino acids, so there many places where sequences from one tissue to another have the same sequences.
If your immune system identifies one protein as a bad guy, its not hard for it to mistake another that looks pretty similar. And this is also a natural process, part of the job of your immune system is to get rid of old dead cells.
Let’s take a look at Hashimoto’s as an example:
According to a study from the UK, 14.3 % of Hashimoto’s patients had another autoimmune diseases, with rheumatoid arthritis being the most common. Here’s a list of other common autoimmune diseases that this population could have:
According to Dr. Datis Kharrazian, DC, autoimmune disease is a progressive disease that goes through 3 stages. While these are not recognized by the general medical community, they are very useful clinically.
As I stated above, autoimmune disease is not officially recognized until close to 70 to 90% of the target tissue is destroyed. Wouldn’t it be better to have some other way to identify these diseases before they destroy the target tissue? For my way of thinking the answer is YES!
Stage 1: Silent Autoimmunity
In this stage, the body has lost tolerance to its own tissue, but there are no symptoms yet and it doesn’t really affect the way that the system functions. This stage can, however, be identified by lab tests that show elevated antibodies.
People can stay in this stage for years. This is the best place to begin some sort of treatment because your odds of getting good results are highest.
Stage 2: Autoimmune Reactivity
In this stage, the destruction of the target tissue has begun. There are elevated antibodies and some symptoms. However, the destruction is not significant enough to actually be labeled autoimmune disease because 70 to 90% of the target tissue has not yet been destroyed.
This stage is where a lot of Hashimoto’s patients are. They may or may not have been placed on thyroid replacement hormone and that may or may not have normalized their thyroid lab results. However, the destructive autoimmune process is active and is progressing.
This is a very important stage for treating the immune dysfunction because you have a greater chance to slow or stop the destruction of that tissue and slow the progression to other autoimmune diseases.
Stage 3: Autoimmune Disease
This is the stage where Western medicine finally acknowledges that this is an autoimmune disease. And it takes this long because you need significant destruction of tissue in order to see the destruction with an MRI or ultrasound.
Other findings include elevated antibodies, serious and significant symptoms, lab results, and special studies that all confirm a loss of function.
Unfortunately, this is really late in the game. With Hashimoto’s, this is the stage where the thyroid is almost completely destroyed. Most people don’t reach this stage before they have been given thyroid replacement hormone because the symptoms have already become so serious that they will have sought out a doctor to help them before they got here.
Research on the effects of thyroid hormone therapy suggest that L-T4 (Levothyroxine) does reduce goiter size and autoantibody levels, however it does not seem to have an effect on specific immune cells that are known to be involved in autoimmune attacks.
That being said, there is evidence that taking thyroid hormone replacement in Stage 1 or Stage 2 may help slow the progression of the disease and this includes its progression to other diseases.
According the Mary Shomon, thyroid advocate, “The practice of treating patients who have Hashimoto’s thyroiditis but normal range thyroid function tests is supported by a study, reported on in the March 2001 issue of the journal Thyroid.
In this study, German researchers reported that use of levothyroxine treatment for cases of Hashimoto’s autoimmune thyroiditis where TSH had not yet elevated beyond normal range (people who were considered “euthyroid”) could reduce the incidence and degree of autoimmune disease progression.
In the study of 21 patients with euthyroid Hashimoto’s Thyroiditis (normal range TSH, but elevated antibodies), half of the patients were treated with levothyroxine for a year, the other half were not treated.
After 1 year of therapy with levothyroxine, the antibody levels and lymphocytes (evidence of inflammation) decreased significantly only in the group receiving the medication. Among the untreated group, the antibody levels rose or remained the same.
The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto’s disease reduced the various markers of autoimmune thyroiditis, and speculated that that such treatment might even be able to stop the progression of Hashimoto’s disease, or perhaps even prevent development of the hypothyroidism.”
Thyroid hormone may definitely provide some benefits, and there are also natural sources of thyroid hormone for those in stage 1 or stage 2 who may want to go the natural approach.
In my practice, we use a product that has thyroid glandular and a number of other herbs and supplements that support the thyroid gland, thyroid hormone function, thyroid hormone receptor binding and promotes healthy T3 and T4 levels.
Even though the research mentioned above has shown that there may be some benefit to thyroid replacement therapy, for many people it is not enough. The reasons for this is simple, they are doing nothing to stop the triggers that drive flare ups of the autoimmune attack and they are not working to balance the immune system.
For example, there are many things that can be done to strengthen the regulatory part of the immune system (this is the part that slows the attack). It is also important to assess and treat the parts of the immune system that are responsible for the assault on your own tissue.
In future posts in this series I will go in depth about how this works and give you some real clinical examples for how we assess, treat and balance the immune system.
Autoimmune disease is on the rise. It must be taken seriously and anyone with hypothyroid symptoms should be tested for thyroid autoimmune antibodies to rule out Hashimoto’s. Thyroid hormone may help slow the destructive inflammatory process, but by itself it is not enough.
There is a lot you can do to balance your immune system and heal your Hashimoto’s. Because I have Hashimoto’s and another autoimmune disease (Ankylosing Spondylitis) myself I have had to focus on healing and managing autoimmunity.
I’m happy to speak without you about how you can do this effectively, as well. Click here to set up a time to chat: Click here to book a session with Marc
What are your thoughts, comments, questions about this issue?
http://www.ncbi.nlm.nih.gov/pubmed/20103030
https://www.jstage.jst.go.jp/article/endocrj/52/3/52_3_337/_pdf
http://hypothyroidmom.com/hashimotos-your-body-is-not-supposed-to-destroy-itself-right/
http://thyroid.about.com/bio/Mary-Shomon-350.htm
http://www.ncbi.nlm.nih.gov/pubmed/16006728
http://www.thyroidweek.com/en/be-thyroid-aware.html
Hashimoto’s and pregnancy are linked in many ways. Hashimoto’s is the most common autoimmune disease in the United States and pregnancy is one of the factors that can lead to it. Many people do not know that thyroid hormones can also affect the hormones that are responsible for fertility and successful pregnancies. In this blog post, I will explore how the thyroid and thyroid hormones may affect a woman’s ability to have a baby.
Before we look at how thyroid hormones can affect pregnancy, let’s review some of the basics of the hormones used to make babies and how they work.
Estrogen
Estrogen rises and falls and helps to orchestrate a woman’s cycle. It makes the lining of the uterus thick so that an egg can be implanted and can grow happily there. The body signals the pituitary gland which helps to control the increase and decrease of this hormone. At the end of the cycle a sharp fall in estrogen and progesterone signals the uterus that there is no pregnancy.
Follicle Stimulating Hormone (FSH)
As its name implies, Follicle Stimulating hormone stimulates the follicles in the ovaries to grow. When estrogen levels drop at the end of the cycle, FSH levels go up (this is what is called a negative feedback loop) to start the process all over again. Once the follicles in the ovaries are stimulated, one becomes dominant and it starts secreting estrogen. This is when the effects of estrogen on the lining of the uterus take place and prepare it for nurturing the egg.
Luteinizing Hormone (LH)
At mid cycle (about day 14), the lining of the uterus stimulates a large and sudden release of luteinizing hormone. When this happens, there is a sudden rise in body temperature and this is a sign that ovulation is about to happen. This surge also causes the follicle to break open and release an egg into the fallopian tubes.
Progesterone
When the follicle breaks open, its walls collapse and this cavity is called the corpus luteum. After ovulation, the corpus luteum begins secreting large amounts of progesterone, which helps prepare the lining of the uterus for the fertilized egg.
Human Chorionic Gonadatropin (HCG)
Made popular by the recent diet fad, this hormone is released once the egg is fertilized. It keeps the corpus luteum healthy so that it can continue to pump out more estrogen and progesterone. This keeps the lining of the uterus healthy. After about 6 to 8 weeks of gestation, the newly formed placenta takes over the secretion of progesterone.
As you can see, a lot of things must happen to have a healthy egg implanted in a healthy uterus to make a healthy baby. If there are problems with any of these hormones or their release, then there will be problems with pregnancy and fertilization. As it turns out, thyroid hormone can affect all of these hormones.
When women have hypothyroidism, a common problem is an increase of another hormone called prolactin. This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle. All of these losses lead to problems with ovulation, and they also mess with the communication to the pituitary gland.
Using birth control pills on top of this can further harm the communication and feedback loops in this system. Using herbs to stimulate the ovaries or the reproductive system will also not work unless the hypothyroid issues are corrected.
Studies have found that even mild hypothyroidism may cause ovarian problems. Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.
Hypothyroidism may lead to low FSH levels, which may lead to immature follicles and infertility. Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels. These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.
To summarize, hypothyroidism can cause:
* A decrease in FSH release and FSH receptor sensitivity, this leads to problems with the development of the follicle and infertility
* Suppressed LH which leads to problems with ovulation and abnormal progesterone levels, this leads to abnormal cycles and infertility
* Progesterone receptor insensitivity which also leads to abnormal cycles and infertility
* Increased Prolactin, which leads to problems with ovulation, abnormal menstrual cycles and infertility
First of all, don’t assume your OB/Gyn or endocrinologist have any idea about this. Some do, but many do not, that’s the sad truth.
Secondly, visit this website: www.hypothyroidmom.com, this is a excellent site full of great information from a woman who has been through it.
Let me summarize her suggestions because they are brilliant:
Get a full thyroid panel (TSH, free T4, free T3, and antibodies if you haven’t tested for them before). Some doctors recommend the range for TSH prior to conception of 1.0-2.0 mIU/L. This is in keeping with the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum.
Here is their actual recommendation:
“RECOMMENDATION 15 – Treated hypothyroid patients (receiving thyroid hormone replacement medication) who are planning pregnancy should have their dose adjusted by their provider in order to optimize serum TSH values to <2.5 mIU/L preconception. Lower preconception TSH values (within the non-pregnant reference range) reduce the risk of TSH elevation during the first trimester.”
Your chances of success are better if you know your body and how it is working. Women with Hashimoto’s or hypothyroidism often have lower than normal body temperature. Keep track and find out when your body temperature goes up because, as I stated above, this signals ovulation, the best time to make babies.
Don’t wait to have no period, buy lots of pregnancy tests and test early and often. The developing fetus relies almost entirely on the mother for thyroid hormone. Hypothyroid Mom, Dana Trentini, sums it up beautifully:
“In a person with healthy thyroid function, her body is able to meet the extra demands of pregnancy to provide the fetus with the necessary hormones. In a woman with thyroid dysfunction, her body may not be able to meet the increased demand for thyroid hormone during pregnancy. According to the Endocrine Society’s 2007 Clinical Guidelines for the Management of Thyroid Dysfunction during Pregnancy and Postpartum, thyroid replacement dosage usually needs to be incremented by 4-6 week gestation and may require a 30-50% increase in dosage.”
This is HUGELY IMPORTANT. Because if your TSH levels or T4 levels get too low, it can seriously threaten your baby and you could lose him or her.
According to the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum:
RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.
RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.
RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation
Like so many things that involve Hashimoto’s, you need to be proactive and armed with knowledge and information to deal with your condition because many doctors and practitioners out there don’t know how to deal with you. This is why I have created Healing Hashimoto’s: The 5 Elements of Thyroid Health, an effective system for understanding and managing your Hashimoto’s. Click on the link to the right to watch my 4 part video series and learn more.
References:
http://hypothyroidmom.com/hypothyroid-moms-story-of-hope-her-miracle-babies/
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum
Thyroid lab tests are the general standard for measuring function and to determine what is or is not working. While these tests can be very effective in helping you discover where the problem might be, they are not perfect. And for those people with Hashimoto’s they can be misleading.
This is simply because all your thyroid numbers may look fine, but you still feel may like crap. Laboratory tests of thyroid function do not account for flare ups and do not really tell you anything about how your immune system is functioning. In a future post, we will take a look at how to better assess your immune system.
The way the thyroid works in the body is kind of like a bucket brigade. Hormones pass the tiny bucket from the brain, to the pituitary gland, to the thyroid gland, to the liver, and finally to the cells of the body.
The body sends a message to the brain and says “Let’s pick it up!” or “Slow your roll!” (speed up or slow down the metabolism). The part of the body that receives this message is the hypothalamus. The hypothalamus delivers the message to the pituitary gland using thyrotropin releasing hormone (TRH). The brain secretes thyroid stimulating hormone (TSH) which tells the thyroid to make and secrete T4 and T3.
The body can only use T3 and only 7% of it comes from the thyroid gland. The body has to convert the rest from T4. This happens in the liver, the gastrointestinal tract, and in other parts of the body like muscles, the heart, and nerve cells.
So, if your liver isn’t working properly or you have gastrointestinal issues like leaky gut or unhealthy gut flora (bacteria), or your pituitary gland is tired, or you have too many thyroid binding proteins in your blood from too much estrogen or you have an immune problem, you can wind up feeling lousy. It is not uncommon for people to have more than one of these issues at the same time.
And your test results might look perfect. In my last post I discussed how systems of the body are affected by the thyroid. Here you can see how the opposite is also true. All of these systems affect how the thyroid works.
With Hashimoto’s, a lot of what may be causing your symptoms is an autoimmune attack on different tissues of your body. Often, people with autoimmune disease have multiple tissues being attacked and this has less to do with the thyroid than with the immune system.
Typical Lab range: (see below)
Functional range: 1.8 -3.0 mU/L
Thyroid stimulating hormone (TSH), also called thyrotropin is released by the pituitary gland after the hypothalamus releases TRH (thyrotropin releasing hormone). TSH is the most common and most sensitive marker used to assess thyroid function.
Many laboratories have now taken to doing what is called a “thyroid cascade” in order to save themselves and insurance companies money. Basically, if the TSH is deemed to be in the normal range they will not analyze for T3 or T4 or anything else. The problem is, there isn’t a lot of agreement about what the “normal range” is.
Since 2003, the American Association of Clinical Endocrinologists has recommended that the normal range run from 0.3 to 3.0, versus the older range of 0.5 to 5.5. So, according to the new standards, levels above 3.0 are evidence of possible hypothyroidism, and levels below 0.3 are evidence of possible hyperthyroidism. However, there is disagreement among practitioners, and some follow the older range, others use the newer range.
An important thing to understand about TSH is that it is an inverse number when thinking about thyroid function. The higher it is, the more sluggish, under achieving and, generally, slow your thyroid is. The lower it is, the more hyperactive, overachieving and, generally doing too much your thyroid is. Put another way: High TSH = hypothyroid, Low TSH = hyperthyroid.
TSH levels increase as T4 levels drop and TSH levels decrease as T4 levels rise. The reason this is the most popular test in today’s medical model is because the only treatment offered for thyroid dysfunction is thyroid hormone replacement and that’s what doctors are checking when they test your TSH.
A TSH test alone doesn’t give you information about thyroid pituitary communication, about T4 to T3 conversion in other parts of the body or about whether or not your immune system is attacking your thyroid. One important thing for Hashimoto’s people to understand is that some antibodies can inhibit thyroid function by turning off instead of stimulating TSH receptors on cells. In this case, you will see high TSH and high antibodies.
Laboratory range is somewhere between 0.3 (to 3.0) and (0.5 to) 5.5. That is a huge range and borders on the ridiculous. The lab range values are made based on the general population that goes to the lab.
Most people who go to the lab are taking thyroid hormones or are poorly managed or completely undiagnosed (or all of the above) so this is not really a good measure of optimal thyroid health. Practitioners of functional medicine (like yours truly) look at a narrower range that we and some endocrinologists believe is a much better range for assessing a healthy thyroid.
This range is: 1.8 to 3.0. Notice it is higher on the low end and equal to or lower on the high end. Less is more, people, when comes to monitoring a healthy thyroid.
Typical lab range: 5.4 – 11.5 ug/d
Functional range: 6-12 ug/d
The TT4 test measures both bound and unbound thyroxine levels and is not a good marker for T4 activity when measured alone. Total T4 is increased with lower TSH and is decreased with higher TSH. It is decreased with low TSH when the pituitary gland is not functioning properly (pituitary hypofunction).
Many drugs can alter total T4 levels. In my book Roadmap to Remission I explore these interactions.
Typical lab range: 0.7 – 1.53 ng/dl
Functional range: 1.0 – 1.5 ng/dl
Free T4 is used to measure the amount of free or active T4 in the blood. High with hyperthyroidism, low with hypothyroidism. The drug Heparin can also cause elevated free T4 as can some acute illness. Its also high in an overdose of thyroid hormone.
Typical lab range: 4.6 – 10.9 mg/dl
Functional range: 1.2 – 4.9 mg/dl
On its own, this test is pretty useless. Total T4 and T3 Uptake are both used to calculate this marker (TT4 x T3 Uptake = FTI). Prescription drugs often affect T4 and resin T3 uptake levels in opposite ways (if T4 goes up resin T3 uptake goes down and visa versa). Many of these drugs affect thyroid hormone binding sites on cells. FTI is increased in thyroid hyperfunction and decreased in thyroid hypofunction and when your body needs selenium.
Typical lab range: 60-181 ng/dl
Functional range: 100 – 180 ng/dl
Total T3 gives you the total concentration of T3 in the blood. It is the preferred test for thyrotoxicosis (hyperthyroid condition, like Graves disease). Total T3 can also be useful in identifying problems of conversion from T4 to T3 in body tissue involving the enzyme 5′-deodinase.
This enzyme both converts T4 to T3 and stops T4 from working in the body.
Typical lab range: 24 – 39 md/dl
Functional range: 28 – 38 md/dl
This test measures the amount of sites for unbound T3 to bind on thyroxine-binding proteins. Many medications can cause high or low resin T3 uptake. In my program Healing Hashimoto’s: The 5 Elements of Thyroid Health we explore these interactions. Elevated testosterone or testosterone replacement therapy can reduce the number of these binding sites.
This causes a low T4 measurement because it leaves very few binding sites for thyroid hormone to attach to. In contrast, anything that raises the number of binding sites, like estrogen or birth control pills will cause a pattern of high total T4 and low T3 uptake.
To summarize, T3 uptake is increased with hyperthyroid and with high testosterone. T3 uptake is decreased with hypothyroid and high estrogen levels.
Free Triiodothyronine (fT3)
Typical lab range: 2.30 – 4.20 pg/ml
Functional range: 3.0 – 4.0 pg/ml
This test measures the free T3 hormone levels. This test is rarely ordered by traditional endocrinologists and is usually only used when a patient has hyperthyroid symptoms and the fT4 levels are normal.
Even so, this test can be really useful for finding out what amount of active thyroid hormones are available for the thyroid receptor sites. Free T3 is high in hyperthyroid conditions and low in hypothyroid conditions.
Typical lab range: 90 – 350 pg/ml
Functional range: 90 – 350 pg/ml
This test measures the amount of reverse T3 that is produced (duh!). Reverse T3 is usually produced when there is an extreme amount of stress. For example, a serious car accident, or surgery or really bad chronic stress.
Its no surprise that this is elevated after a stress response or when the body produces high amounts of the stress hormone cortisol. Reverse T3 is low when you have severe tissue damage like a bad burn or laceration or when you have liver disease like cirrhosis.
Thyroid-Binding Globulin (TBG)
Typical lab range: 15 – 30 ug/dl
Functional range: 18 – 27 ug/dl
Thyroid-binding globulin binds thyroid hormones that are circulating throughout the body. It is the main protein for carrying both T4 and T3 in the blood. This test may help determine thyroid problems from things not directly related to the thyroid like drugs, liver disease, infection, stress from surgery, etc.
Many drugs can alter TBG levels. In my book Roadmap to Remission I explore these interactions.
Typical lab range for all antibodies: Above the laboratory range
When these antibodies are present, it means that your immune system is attacking your own tissue. When your body produces thyroid autoantibodies it could create a hypo- or hyper- thyroid state. They may also be elevated if there is thyroid cancer. Some antibodies can attach to TSH receptors, but they don’t cause a response in the thyroid.
These people will complain of low thyroid symptoms, but the TSH might not change at all. In other cases, the antibodies bind to receptor sites and cause the thyroid to be over active. Here you will see high T4, low TSH and high antibodies.
There are 3 autoantibodies that are tested. The first 2 are the most common:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production. TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
Thyroid-Stimulating Hormone Receptor Antibody (TRAb): This antibody is only ordered when a patient is hyperthyroid. Positive results usually mean Grave’s disease.
Once you have tested antibodies and they are high, you have established that you have Hashimoto’s. Of course, these should be looked at in the context of other tests to determine how your thyroid is functioning.
Testing antibodies again is not that helpful for patients with Hashimoto’s because antibody levels can change throughout the day and may rise and fall without giving you any real relevant information about how well you are managing your disease.
They are also not a god indication of how your immune system is doing.
Antibody levels getting higher is not necessarily a bad thing, it can be an indication that treatment has stimulated a certain aspect of your immune system.
And antibody levels going down is not automatically a good thing, it may not lead to any improvement in symptoms.
The reality of having Hashimoto’s is that, in many cases, you have to take matters into your own hands to get proper care. This condition is one of the most poorly managed conditions in healthcare today. This is certainly true with lab tests.
The best thing to do is to work with a practitioner who knows what they are doing and who can order tests to properly assess you thyroid. This way and you can know if what you are doing is working or not.
Be prepared that you may have to come out of pocket to pay for these tests yourself if your doctor or your insurance company don’t deem them medically necessary.
The good news is that laboratory tests have become much more affordable and some functional medicine practitioners, like myself, pass this savings onto their patients because we believe you shouldn’t go broke to get better.
Interested in learning more? Check out this post for a more complete overview of lab tests fro Hashimoto’s.
Hashimoto’s is a thyroid condition and an autoimmune condition, both issues must be addressed to successfully manage this condition. Please let me know your thoughts and questions, I’d love to hear from you.
Resources:
Mastering the Thyroid, 2011, Kharrazian, Datis, DC
http://www.netplaces.com/thyroid-disease/hypothyroidism/blood-tests.htm
In my last post I looked at 6 different systems and how they were affected by the thyroid and, how that affected Hashimoto’s patients. This is part 2 of that post. And, as I stated in that post, some of this material comes from Dr. Datis Kharrazian, one of the world’s leading experts in the treatment of thyroid issues using functional medicine and from another book called The Thyroid, A Fundamental and Clinical Text, by Braverman and Utiger.
The reason this is important is because the things that you are feeling are not a coincidence or some random group of symptoms. They are caused by your thyroid not functioning properly.
And often, there is a back and forth relationship where a problem or weakness in one of these systems can actually make the problem in your thyroid worse. This is why a holistic approach that treats these various systems is so important.
In our last post, we looked at these systems:
1. Bones and bone growth
2. Blood sugar metabolism
3. Brain
4. Cholesterol and other fats in the blood
5. Gallbladder
6. Cardiovascular system
7. Intestines
8. Liver
9. Maintaining Weight
10. Protein metabolism
11. Red blood cell metabolism
Thyroid hormone has a direct affect on movement through the entire gastrointestinal tract. Thyroid hormones increase intestinal neurotransmitters, increase blood flow to the intestines and support the repair and regeneration of the intestines.
Hypothyroidism can slow movement through the esophagus, can affect muscle function in this area and can affect the nerves that cause movement. Hypothyroidism also has an affect on the vagus nerve and this can lead both directly and indirectly to slowing movement through the intestines.
This can lead to 3 common problems:
1. Constipation: One of the most common complaints of Hashimoto’s and hypothyroid patients is constipation. When the bowels slow and it takes more time to empty.
2. Malabsorption: People with hypothyroid problems and Hashimoto’s can have difficulty absorbing important vitamins, minerals and nutrients from their foods. This can lead to a host of health problems including, low protein, anemias, and vitamin deficiencies. Hyperthyroid patients can experience diarrhea that can also lead to poor absorption.
3. Dysbiosis: Hashimoto’s and hypothyroid people often have issues involving problems in the intestinal tract with overgrowth of yeast, harmful species of bacteria and fungus.
When you add the problems caused by gluten and cross reactivity to the slowing of movement and repair in the intestines you have a recipe for a really vicious cycle. Gluten causes breakdown of the lining, slow transit and slower repair and this means that the damage done is compounded and each makes the other worse.
T4 that is secreted by the thyroid gland is converted by the liver into T3 which then has effects on the body. Patients with liver diseases, like cirrhosis have problems converting T4 into T3. High TSH has also been found to cause an abnormal response in the pituitary gland, which signals the thyroid to release more hormones.
Hypothyroid and Hashimoto’s patients also experience issues involving the liver. A hypothyroid state can lead to problems with detoxification pathways, especially phase II detoxification. This can lead to a clogged liver and more problems with converting T4 to T3. This is the reason why liver detoxification is so important for Hashimoto’s patients whether or not they are taking thyroid hormones.
Many Hashimoto’s patients have issues maintaing a proper weight. For some it is due to a low thyroid state, for others it is due to a hyperthyroid status.
For those who are unable to lose weight, there are several different reasons for this. Thyroid hormones are responsible for metabolic activity, a slower metabolism means an inability to lose weight or, in some cases, weight gain. A hypothyroid state can also slow the the body’s ability to use free fatty acids, when this happens fat can not be broken down.
A slower metabolism and fat not breaking down can both lead to fatigue. Hypothyroidism can also cause less growth hormone to be produced, this can lead to loss of muscle mass and the inability to build muscles.
For Hashimoto’s people who have difficulty gaining weight, their problem is that their thyroid is undergoing an immune attack and is in hyperthyroid state. This can last for an extended period of time. Eventually, in Hashimoto’s patients, they get to a hypothyroid state due to thyroid tissue destruction.
If a patient stays in a hyperthyroid state, then Grave’s disease should be considered and a tissue biopsy should be ordered. Also, in Graves disease TSH autoantibodies will be very high. In Hashimoto’s TPO (thyroid peroxidase) antibodies will be highest, with or without TSH antibodies.
When someone is hypothyroid, serum protein levels may be increased because capillaries dilate and allow larger proteins into the bloodstream. Albumin also breaks down more slowly. This can be seen in elevated protein in both the blood and the urine.
A hypothyroid state can lead to several different types of anemia.
Normocytic normochromic anemia: Hypothyroidism can cause a decrease in the production of the hormone erythropoeitin and this may cause this type of anemia. There are about 14 different kinds. For this treatment should be focused on the thyroid.
Macrocytic anemia: Low thyroid activity can lead to this because of a decrease in absorption of vitamin B12 and folic acid caused by a decrease in hydrochloric acid. For this, one must rule out the autoimmune condition below and if it is not autoimmune supplement with B12, folic acid and, possibly hydrochloric acid.
Pernicious anemia: This is an autoimmune disease caused by an autoimmune attack on intrinsic factor which is responsible for helping the body break down and absorb vitamin B12. One of the realities of autoimmune disease is that there are sometimes multiple tissues being attacked.
In about 12% of Hashimoto’s patients, there is also an autoimmune attack on intrinsic factor. If you suspect this type of anemia, an Intrinsic Factor Autoantibody test can be ordered. (IF ab). If this is positive, then they have pernicious anemia. These people respond better to B12 injections.
Iron deficiency anemia: Hypothyroidism can also affect iron absorption because of decreases in stomach acid and excessive blood loss from progesterone receptor site resistance. If iron is deficient, TIBC (total iron binding capacity) should be checked. This will be elevated in iron deficiency and is a good marker to see early iron deficiency. For this, supplement with iron, hydrochloric acid and, possibly, vitamin C to enhance absorption.
Whenever you see an abnormal pattern in a CBC (complete red and white blood cell count) then the thyroid should be evaluated. And when someone sees a thyroid issue, a CBC should always be evaluated.
And here is why this matters: if a patient is anemic, they are not getting enough oxygen to their cells and nothing you do is going to be effective. If you don’t fix this, all the treatments that you attempt will be exercises in futility because the cells of the body are not being powered properly.
Bottom Line:
The body is not a machine with a series of unrelated parts. It is a group of inter-related ecosystems that all affect one another. When treating Hashimoto’s, it is important to understand these relationships and to work on healing and balancing the body. This will lead to faster, better and more long lasting results. This is why I created Hashimoto’s Healing: The 5 Elements of Thyroid Health. This system gives you the tools to do this and to radically improve your results in managing and healing your Hashimoto’s.
References:
Kharrazian, Datis, DC Mastering the Thyroid, 2011
The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman & Robert D. Utiger, 2005, Lippincott Williams & Wilkins
Green JR, Diminished TSH repines to TRH stimulation in patients with hepatic cirrhosis dispute subnormal T3 levels. Z. Gastroenterol. 1979:17(7):447-51
Saha B, Maity C. Alteration of serum enzymes in primary hypothyroidism. Clin Chem Lab Med. 2002;40:609-611