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Thyroid Lab Tests: A View From the Inside



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.

Why Do I Still Have Symptoms Even Though My Thyroid Lab Tests Are Normal?

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.

TSH, The Standard That No One Can Agree On

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.

Bottom Line on TSH

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.

Total Thyroxine, (TT4)

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.

Free T4

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.

Free Thyroxine Index (FTI)

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.

Total Triiodothyronine (TT3)

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.

Resin T3 Uptake

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.

Reverse T3 (rT3)

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.

Thyroid Antibodies

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.

If Your Antibodies Are High Should You Retest Them to Monitor Progress?

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.

How Can I Order These Tests If My Doctor Only Orders TSH?

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.

Final Thought

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.


Mastering the Thyroid, 2011, Kharrazian, Datis, DC




How The Thyroid Affects 11 Different Systems of the Body


The Thyroid Affects So Many Parts of the Body

In today’s health care system there are many specialists. It is easy to lose track of the fact that the body is a group of ecosystems, all interconnected and interacting. The thyroid is a perfect example of all these complex interactions and connections.

I have been a long time student of Dr. Datis Kharrazian, one of the leading experts of the treatment of the thyroid with functional medicine and author of the book, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?. (This book should be required reading for anyone diagnosed with Hashimoto’s). The material in this post comes from some of my studies with him and from a book called The Thyroid, A Fundamental and Clinical Text, by Braverman and Utiger.

The body is not just a bunch of unrelated machine parts. Everything is connected in some way.

When you have Hashimoto’s, chances are good that you have symptoms in some other areas of your body. Read on and you will understand why.

The Thyroid Directly Influences 11 Different Systems in the Body

That’s right, 11. In this 2 part blog post we will introduce each one of them briefly and also discuss how these connections affect Hashimoto’s patients. I will also be exploring all of these in more depth in future posts. Please let me know what interests you.

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 Proper Weight

10. Protein metabolism

11. Red blood cell metabolism

Thyroid and Bone

Low TSH or a hyperthyroid state can lead to an increased lifetime risk for fractures, even after TSH has become normal again.

In children, a lack of thyroid hormones will affect normal growth.

Adult hypothyroid and some Hashimoto’s patients tend to have higher than normal bone density. But, this higher density does not necessarily mean good bone quality: there may be issues with collagen, bone turnover, the size of mineral crystals and bone structure. So, even though the bones are more dense, these people may still be at risk for fractures because the bone quality is really poor.

IL-6, an inflammatory cell commonly seen elevated in Hashimoto’s patients can also lead to bone loss.

Thyroid and Blood Sugar

Blood sugar is controlled by the pancreas. The pancreas and thyroid are both part of the endocrine system. The endocrine system is made of many feedback loops and their various hormones all “talk” to one another and make changes to the body to try and keep things in balance.

These systems also work in both directions. They influence each other. In the case of sugar, insulin is released by the pancreas to help the cells of the body absorb sugar so that it can be used. And the adrenals release cortisol to help sugar get absorbed by the cells of the body.

A hypothyroid state leads to a slow absorption of glucose, a slower breakdown of insulin, a decrease of the speed at which glucose is absorbed in the gut, a lower glucose to insulin response and, finally, less glucose in the cells for the body to use. All of this means less energy to power your cells and brain and more fatigue.

To make matters worse, all of this affects the adrenal glands and the hypothalamus-pituitary-adrenal axis (HPA axis). In order to try and fix the problem of not having enough sugar, the adrenal glands release the stress hormone cortisol to increase glucose in the cells.

Every Hashimoto’s patient has some degree of the sugar imbalance described above. If you are skinny, its probably hypoglycemia. If you are overweight it may be insulin resistance or metabolic syndrome. If you feel better after you eat, you are hypoglycemic. If you are tired after you eat, you have insulin resistance.

All of this creates a vicious cycle that can really stop you from getting better. All Hashimoto’s patients must take blood sugar problems seriously. You won’t get better unless you do. In my six week program you will discover how to do this. Click on the link to the right get my 4 video series and learn more.

Thyroid and the Brain

Thyroid hormones are very important for healthy brains. In the adult brain, thyroid hormones have shown the ability to help the brain grow and change and to help the brain age in a healthy way.

Hashimoto’s patients know about “brain fog”. There are many reasons for this, the principle ones being inflammation of the brain and a breakdown of the blood brain barrier. The proteins that protect the brain (called zonulin) are the very same proteins that protect the gut. So if you have leaky gut, there is a good chance that you also have leaky brain.

When your brain is inflamed you get brain fog and it degenerates.  There are 2 primary symptoms:

1. Depression

2. Fatigue

It is no surprise that the most common drugs prescribed with Hashimoto’s are anti-depressants. You absolutely must support your brain if you have these symptoms.

Brain fog is a brain cell activated immune response. The immune system in the brain is not specialized and sophisticated like the immune system in the rest of the body. Brain immune cells (called microglia) are kind of like paranoid chihuahuas with automatic rifles. They tend to over react quickly and when they do you get lots of inflammation (brain fog).

In some patients, thyroid hormone may improve brain fog. In others it won’t. You have to reduce inflammation in the brain in a different way. In my 6 week course you learn how to do this and what herbs and supplements can really help with this. One important herb that is used is turmeric. Click on the link to the right to get my 4 video series and learn more.

Thyroid and Cholesterol

In hypothyroid conditions, both the breakdown and the use of cholesterol by the body are depressed. But the breakdown is much slower, so the net result is higher cholesterol, triglycerides and LDL. This may be slower because of a decrease in the breakdown of fats once they leave the liver or in a decline of LDL receptors.

This is why some Hashimoto’s patients also have high cholesterol, triglycerides and LDL (and sometimes low HDL). Once they get their thyroid under control, it is not unusual to see their cholesterol, LDL and triglycerides return to normal as well.

Thyroid and Gall Bladder

Gall bladder function is also adversely affected in hypothyroid conditions. Studies have shown that the gall bladder gets larger and doesn’t contract normally.

Studies also report an increase in the number of gallstones and stones in the common bile duct. One reason they think this might be happening is because the thyroid hormone thyroxine relaxes the gall badder’s opening (called the sphincter of Oddi). This makes bile not flow normally, and makes the possibility of stones forming in the bile duct more likely.

Bile also helps to break down cholesterol so when there is less bile, less bile flow and gall bladder is slow and sluggish you have the perfect situation for stone formation.

Thyroid and Cardiovascular System

Thyroid hormones have a big impact on many functions of the arteries and veins in the body. Low T3 levels have been linked to  diseases of the blood vessels. One of the most common problems that Hashimoto’s patients have is cold hands and feet. Hair loss and fungal nail growth can also be signs of poor blood flow.

Low thyroid function means less nitric oxide is available in the blood vessels, this can lead to a break down of the vessels themselves.  When you add in the problems with cholesterol and you have a recipe for plaque clogging the arteries.

For those patients taking levothyroxine, some of these problems have been shown to be reversed by the medication.

Bottom Line

All those symptoms that you experience are not by accident or some coincidence. There are very clear reasons why your body is experiencing what it is going through. The goal of this blog, my website and my program are to help you to understand how all this works in simple terms, so that you can discover how to get control of your health.

That’s why I created my program Healing Hashimoto’s: The 5 Elements of Thyroid Health. To give you all the information and solutions in 1 place, to teach you how to better manage your Hashimoto’s and to make the goal of having more goods days than bad ones easy to reach.


Lakatos P., Thyroid hormones: beneficial or deleterious for bone? Calcif Tissue Int. 2003. Sep;73(3):205-9

Muller MJ, Burger AC, Ferrannini E, et al. Glucoregulatory function of thyroid hormones; role of pancreatic hormones. Am J Physio. 1989;256:E101-E110

Calza L, et al. Thyroid hormone-induced plasticity in the adult rat brain. Brain Res Bull. 1997;44(4):549-57

Flavin RSL, et al. Regulation of microglial development: a novel role for thyroid hormones. The Journal of Neuroscience. 2001;21(6):2028-2038

Oge A, Sozmen E, Karaoglue AO. (2004) Effect of thyroid function on LDL oxidation in hypothyroidsim and hyperthyroidism. Endocr Res 2004; 30:481-489

Laukkarinen J, Kiudelis G, Lempinen M, Raty S, Pelli H, Sand J, Kemppainen E, Haglund C, Nordback I. Increased prevalence of subclinical hypothyroidism in common bile duct stone patients. J Clin Endocrinol Metab. 2007 Nov;92(11):4260-4. Epub 2007 Aug 28

Inkinen J, Sand J, Nordback I. Association between common bile duct stones and treated hypothyroidism.  Hepatogastroenterology. 2000 Jul-Aug:47(34):919-21

Napoli R, Guarasole V, Angelini V, et al. Acute effects of triiodothyronine on endothethial function in human subjects. J Clin Endocrinol Metabl. 2007;92(1):250-4

Taddei S, Caraccio N, Virdis A, et al. Impaired endothelium-dependent vasodilation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. J Clin Endocrinal Metab. 2003:88(8):2731-7

Mastering the Thyroid, Datis Kharrazian, 2011

The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman and Robert D. Utiger, 2005 Lippincott Williams and Wilkins



Hashimoto’s and Iodine: Good Idea or Bad?


Having the right amount of iodine is important for thyroid hormone production. And too little is the most common cause of hypothyroid problems worldwide. Some people think that this means, logically, iodine supplementation would be a good idea for Hashimoto’s patients. It turns out, these people are very wrong.

According to Dr. Datis Kharrazian, DC, who I have been a student of for many years, there is compelling evidence for avoiding iodine if you have Hashimoto’s. Much of the information below comes from his course, Mastering the Thyroid. In addition, check out his comment on his blog here.

Iodine Stimulates TPO (thyroid peroxidase) and Increases Immune Attack 

In the body iodine is a major cofactor and stimulator for TPO. A cofactor is something (usually a vitamin, mineral, enzyme or nutrient) that is used to build something else inside the body. When you have Hashimoto’s, TPO is under attack by your immune system. Increased iodine, especially as a supplement, increases the immune attack on the thyroid.

Graves Disease and Iodine: A Really Bad Idea 

The most extreme example of this is called Jod-Basedow Phenomenon, and it is caused by taking iodine. This occurs when people who are iodine-deficient also have high levels of thyroid antibodies. When they take this supplement, their immune system goes nuts. If you have Graves disease caused by autoimmune disease and you take iodine, you could soon be in a world of hurt.

Hashimoto’s and Iodine: None Can Actually Improve Symptoms

This also holds true for patients with Hashimoto’s. Reports have shown that too much iodine causes hypothyroidism in Hashimoto’s thyroiditis. A study from the Yonsei Medical Journal published in 2003 looked at how not taking this supplement affected patients with Hashimoto’s.

Here’s what they found: “….78.3% of patients with hypothyroidism due to Hashimoto’s thyroiditis regained a euthyroid state (meaning a normal thyroid state) with iodine restriction alone. Both a low initial serum TSH and a high initial urinary iodine concentration can be predictable factors for a recovery from hypothyroidism due to Hashimoto’s thyroiditis after restricting iodine intake.”

In other words, more than 3/4 of the patients returned to a normal thyroid state by just lowering the amount of iodine they took in.

Several Studies Worldwide Show Increased Iodine Equals Increased Autoimmune Thyroiditis

There are several studies with large numbers of people that have shown a direct link between increased iodine and autoimmune thyroid disease. Here are a few:

A study in China looked at 3,018 people and found that “…more than adequate or excessive iodine intake may lead to hypothyroidism and autoimmune thyroiditis.”

In Sri Lanka researchers kept track of the effects of using iodine on thyroid function and they charted their findings for 3 years. This was the first study of its kind. It showed the changes in autoimmune markers as the study went on and showed the increases in autoimmune disease in these people.

In Turkey a study looked at 1,733 adolescents and found that the elimination of iodine deficiency in the Eastern Black Sea region was also followed by an increase in autoimmune thyroiditis and thyroid dysfunction.

Bottom Line

Practitioners and health coaches who tell Hashimoto’s patients to take iodine may be causing a more aggressive autoimmune attack on thyroid tissue. And as many of you may know, lots of people who have Hashimoto’s don’t know that they have it because no one has tested for it even though they have signs and symptoms. This means that ruling out Hashimoto’s is extremely important before taking iodine.

If you have Hashimoto’s you should be cautious about using iodine. 



Surks M., Sievert R., Drugs and thyroid function, NEJM, 1995; 333(25):1688

Yoon SJ, Choit SR, Kim DM, et al. The effect of iodine restriction on thyroid functions in patients with hypothyroidism due to Hashimoto’s thyroiditis. Yonsei Med J. 2003 Apr 30;44(2):227-35.

Eur J Endocrinol. 2011 Jun;164(6):943-50. doi: 10.1530/EJE-10-1041. Epub 2011 Mar 28.

More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels.

Effect of iodine intake on thyroid disease diseases in China, NEJM, 2006, Jun 29;354(17);2783-93

Evolution of thyroid autoimmunity during iodine prophylaxis – the Sri Lankan experience. Eur J Endocrinology, 2003, Aug;149(2):103-10

High prevalence of thyroid dysfunction and autoimmune thyroiditis in adolescents after elimination of iodine deficiency in the Eastern Black Sea Region of Turkey. Thyroid, 2006 Dec;16(12):1265-71








Thyroid Hormones and Gluten Sensitivity




Hashimoto’s patients are often aware of their sensitivities to gluten (and other foods), but one thing that they are often unaware of is that some thyroid hormones have fillers and inactive ingredients that may be triggering a gluten-like reaction.

These fillers are almost never part of the conversation and it is important to understand that they could be actively winding up an autoimmune attack on your thyroid.

Some Thyroid Hormones Contain Corn Starch

One of the more common fillers used in both Synthroid and Unithroid (both synthetic forms of T4) is confectioner’s sugar. This contains corn starch which many sources will tell you is a gluten free product. However, unless the starch is produced in a way that no proteins whatsoever remain, small amounts in the starch may cause a reaction.

Some studies have shown that corn proteins cross react with gluten and this means that these fillers could cause problems because your immune system will react to them in the same way that it does to gluten.

Why should you care? Because if you have Hashimoto’s and you have celiac disease or gluten sensitivity, every time you take your hormone medication you may be causing an immune flare up.

You may, unknowingly,  be creating a kind of daily vicious cycle of immune wind up. Not good.

What Symptoms To Look For

One of the symptoms that you should look for if you are taking these thyroid hormones is that you feel fatigued and run down with thyroid hormones. This is almost always related to sensitivities to the inactive ingredients in the hormones such as dyes and fillers.

If you are taking the hormones and you feel exhausted, this could be a good indicator that you are having a response to the “inactive ingredients”. This could happen if you recently went on the medication, recently switched medication or, in some cases, if the manufacturer changed some of the inactive ingredients in manufacturing. In any case, this is something that you need to rule out.

Testing for Cross Reactivity

There is a lab we work with called Cyrex labs that has a comprehensive cross reactivity test and this is recommended to anyone who has Hashimoto’s or any other autoimmune disease. Testing for cross reactivity to corn is another way to confirm that the reaction you are having is due to cross reactivity.

If your body has developed antibodies for corn or other foods and it reacts to them in the same way that it reacts to gluten, you must eliminate these foods from your diet. Forever, or suffer the consequences.

What are the consequences? The problem with gluten and other cross reactive foods is that they trigger the immune system and when they do this your immune tissue attacks your own tissue.

One important thing to realize is that when you have an autoimmune disease, you often have multiple tissues being attacked and these can include your brain, your joints, the lining of your intestines, your skin, etc.

There are many possible tissues and sometimes those symptoms that you feel that seem unrelated are not unrelated. They are a direct consequence of an autoimmune flare up.

 Other Ingredients In Synthroid May Also Cause Problems

There are some other ingredients in thyroid hormones that may also cause reactions. The other ingredients in Synthroid are: acacia, lactose monohydrate, magnesium stearate, povidine, talc and a number of different food dyes (different for different dosages).

Acacia is a TH-2 stimulator and may cause problems if you are TH-2 dominant. (If you aren’t familiar with this, I will explain in detail in an upcoming post, stay tuned.) Lactose is a common sensitivity for many people as well.

Food Dyes Can Also Cause Problems

And, of course food dyes can cause all kinds of problems all by themselves. Click on this link to learn more. Here is a list of which dyes are in each common dosage of Synthroid:

25 mcg: FD&C Yellow No. 6 Aluminum Lake

50 mcg: None

88 mcg: FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, FD&C Blue No. 10 Aluminum Lake

100 mcg: FD&C Yellow No. 10 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake

200 mcg: FD&C Red No. 40 Aluminum Lake

Bottom Line

If you experiencing symptoms of autoimmune flare up like exhaustion, joint pain, brain fog, etc. and you are careful with the things you know may cause flare ups (gluten, dairy, coffee, etc.), you should check the inactive ingredients of your thyroid hormones. You may be causing flare ups without knowing it.







Other Foods Act Like Gluten?

If you have Hashimoto’s, the chances are that you have gluten sensitivity or gluten intolerance (whether or not it has been diagnosed). Research has shown a strong correlation between the two.

Cross Reactivity: Not Gluten, But Acts Like It 

One important thing that you need to understand is that there are other foods that can act like gluten in your body. And your immune system reacts to them in the same way that it reacts to gluten.

These foods are called cross reactors and even if you are diligent about avoiding gluten, you may be not making the progress you want because you are not aware of these other foods.

Gluten Antibodies Recognize Proteins in Other Foods

Basically, when your body creates antibodies against gluten, those same antibodies notice antibodies in other foods. When you eat those foods, even though they don’t contain gluten, your body reacts like they do.

In the same way that even a small amount of gluten can trigger an immune response, even a small amount of these foods can cause inflammation and an immune response.

Proteins Are Made From Amino Acids

Proteins are made from long chains of amino acids (like those pictured above), and it is the exact sequence of these amino acids that determines how the protein is formed and what it does. The way that the amino acid chains are folded, bent and buckled in different ways determines what the function of that protein is.

Antibodies Are Made For Short Amino Acid Sequences

An antibody is a Y shaped protein produced by immune cells in your body. This antibody is like a lock and the sequence of amino acids is the key that unlocks it. There are different classes of antibodies, IgE, IgA and IgG. All 3 play a part in allergies and food sensitivities and reactions.

IgE is responsible for allergies, like someone’s face blowing up after eating shellfish. IgG and IgA are responsible for food sensitivities and intolerances. They are found in high concentrations in the gut, and also in the lymph fluid, in saliva and in tissues themselves.

When antibodies are made, they recognize specific short sequences of amino acids in a protein. Some of these sequences are more likely to cause antibodies to be created. This is why certain foods tend to cause more allergies and sensitivities than others (gluten, for example).

Lots of Different Foods Have the Same Sequences as Gluten

Gliadin Protein

Since antibodies are formed to these sequences, anything that has them is attacked by the immune system. So, depending on what antibody or antibodies your body forms against gluten, it may or may not cross-react with other foods.

But, if your body makes antibodies for sequences in other foods, then you are not only sensitive to gluten, you are sensitive to all those other foods.

What Foods Cross React With Gluten? 

There is a lab called Cyrex labs that tests for these cross reactors and they offer the following list of foods that may cause a gluten like response in your body:

  • Rye
  • Barley
  • Spelt
  • Polish Wheat
  • Oats
  • Buckwheat
  • Sorghum
  • Millet
  • Amaranth
  • Quinoa
  • Corn
  • Rice
  • Potato
  • Hemp
  • Teff
  • Soy
  • Milk (Alpha-Casein, Beta-Casein, Casomorphin, Butyrophilin, Whey Protein)
  • Chocolate
  • Yeast
  • Sesame
  • Tapioca (a.k.a. cassava or yucca)
  • Egg
  • Coffee

You may notice that some of these are grains that are commonly thought to be gluten free. They may be, but they may also cross react which means they cause the same problems that gluten causes in your body.

And just like we discussed in our last post, only tiny amounts of these foods are needed to cause inflammation and an immune response.

There Is A Solution

In my program, Healing Hashimoto’s: The 5 Elements of Thyroid Health, you will discover more about the tests available to you and learn what you can do to minimize the damage from exposure to gluten and cross reactive foods, and how to clear out circulating antibodies. Click here to learn more.


Gluten Cross-Reactivity: How your body can still think you’re eating gluten even after giving it up. | The Paleo Mom

Autoimmunity, 2008 Feb;41(1):116-121 







For Hashimoto’s, Is It OK to Be “Almost Gluten Free”?

If you are someone who has Hashimoto’s, you have probably already heard about how important it is to be gluten free. Many patients with Hashimoto’s also have gluten sensitivity. In fact, there is a good deal of research that suggests a kind of chicken-or-the-egg argument regarding gluten sensitivity and autoimmunity. Meaning, we aren’t really sure which came first.

2 Problems with Gluten

Let’s face it, the gluten of today ain’t your grandfather’s gluten. Wheat has been all kinds of modified and there are many economic and political pressures to create a super wheat that will reign supreme in today’s industrial agriculture food system.

2 Things Have Happened to Wheat:

Firstly, it has been bred to have more gluten, and to be disease resistant , insect and heat resistant and to survive all kinds of difficulties.

It is also deamidated. Deamidation is a process that creates a dough that has more plasticity and is easier to work with. It also makes wheat based products useful as binding agents and fillers and for emulsifying, forming films, and making stuff more stretchable.

Wheat is in almost everything that is processed. It is used by food scientists in meat products, sauces, soups and as a clarifying agent in red wine.

Modification Has Led to New Kinds of Allergies & AutoImmune Disease

This new super gluten and deamidated wheat messes with your small intestine. It gets deep into the folds (villi), and it confuses the immune system into thinking that it is a foreign invader. The result is a gradual destruction of your intestines. It can also destroy your nerves, your brain, your thyroid and lots of other tissues.

And this is where the chicken-or-the-egg argument comes in. This breakdown of the intestine causes intestinal permeability, but it also causes the immune system to not recognize its own tissue and to start destroying it. So you get this vicious cycle of your intestines leaking, your immune system going crazy and and both things making each other worse. And being gluten free is often the only thing that reverses this process and stops the destruction.

Proteins in Gluten Looks A Lot Like Proteins in Other Parts of Your Body

Proteins are made from amino acids. The body doesn’t have very many of them to work with so they are creatively arranged and rearranged in different combinations. The problem is many of these arrangements look a lot like each other. Especially in certain pieces. In fact, some pieces are exactly the same.

For example, gliadin (gluten) proteins look a lot like proteins in your cerebellum (foggy brain?). Myelin basic proteins look a lot like streptococcus proteins. In fact, when your immune system is making antibodies, antibodies for one of these proteins fit receptors on the others. So these antibodies work for both.

Hashimoto’s Patients Have a Significant Increase In Celiac Disease

Many Hashimoto’s patients have celiac disease or gluten sensitivity. And when they eat gluten, they get flare ups. Sometimes they don’t test positive for allergies to gluten, but this doesn’t mean that they don’t have it.

This is because most doctors only test 2 antibodies to gluten, anti-gliadin antibodies IgA and Transglutaminase IgA. 40% of people test negative for these, even when they are intolerant to gluten.

There are 22 other gluten antibodies that you could have. I work with a lab called Cyrex labs that tests for all of these.

Cross Reactivity Is the Problem

The idea of cross reactivity is this. Those similar amino acid sequences result in an autoimmune attack whenever you have any gluten or anything that acts like gluten. (In my next blog post we will explore what other foods have a similar amino acid sequence to gluten and may act just like gluten in your body.)

This means, if you have antibodies to gluten and you have autoimmune disease, you get flare ups every time you eat those foods. Every time. The immune system is not designed to cheat when you do. It doesn’t disarm antibodies, once created, they work forever.

Can You Be “Almost Gluten Free”?

Back to my original question – and this is an important one because there are many people who think that being almost gluten free is still almost good.

I’m sorry to say the data says NO. A study in the Journal of Neurology, Neurosurgery and Psychology looked at this question and their answer?

“Even minute traces of gliadin are capable of triggering a state of heightened immunological activity in gluten sensitive people.” Crap!

What they are saying is even a little bit, just an eeny weeny bit of gluten, triggers a major immune response. That translates to a flare up of your symptoms and further tissue destruction.

I’m afraid its true, people. One thing you need to realize is that you only need a tiny amount to get a response from your immune system. Antibodies have memories better than elephants.

You have to be vigilant. And you have to do the right testing so that you know what you are dealing with. Its also a good idea to work with people who are aware of these things and who think about how they may affect your care. You also need to know that there are hidden sources of gluten.

Gluten Comes in Many Shapes and Forms

Many people are not aware that you can also react to gluten from things that are not food or stuff that may be in the air. Handling wheat based dog foods, breathing in flour from the air in a bakery, kissing, and skin lotions are common examples where hidden gluten can be found.

Common Sources of Hidden Gluten:

1.) Licking envelopes or stamps
2.) Sauces for meats, salads, etc
3.) Tooth paste
4.) Shampoo
5.) Frying oils
6.) Shared cutting boards or utensils
7.) Grain based sweetener (i.e. malt, corn sugar)
8.) Thickening agents used in processed foods

The bottom line is this – Be careful and read your labels.

The Good News

If you are careful and you eliminate these triggers, you can significantly calm your immune system and slow or stop tissue destruction. There are also some herbs and botanicals that can reduce the damage done from gluten if you are accidentally exposed to it.

Still not convinced?

Check out this other article on Celiac and Hashimoto’s, I looked at over 30 peer reviewed studies on this issue.

Comments, thoughts, suggestions? I’d love to hear your comments on this.





Autoimmunity.2008 Feb;41(1):116-121.Celiac disease in Northern Italian patients with autoimmune thyroid disease

Autism File. 2009;31:56-64

J Neurol Neurosurg Psych. 1997;63:770-775




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