5 Keys to Improving Thyroid Hormone Conversion

As many of you know, all I do is treat Hashimoto’s and over the last 4 years I have worked and spoken with over 2,000 people with Hashimoto’s.

Most of these conversations have happened during my consultations. In these, people share with me their struggles and I offer advice that helps them right away.

By far, the most common theme of these conversations is that they have normal lab results (this usually means TSH and T4 – to learn more about what are better tests to order read this post) and yet they have all the common hypothyroid symptoms.

In other words, they are fatigued, they have brain fog and memory issues, their hair is falling out, the may have depression, constipation, difficulty sleeping and muscle weakness or joint pain and more.

This Common Problem Is Often caused By Poor Thyroid Hormone Conversion

While researchers sometimes claim that this is rare, clinical experience and empirical data prove otherwise. I put this question to my Facebook support group on 2 occasions and over 300 people responded that they have some or all of the symptoms above and “normal” lab test results.

This situation isn’t rare, it’s very common.

Taking Thyroid Hormone But Still Have Symptoms

And the vast majority of these people are taking some type of thyroid replacement hormone. The prescriptions vary from Synthroid to Armour to Levothyroxine and sometimes there’s some Cytomel thrown in or they’re taking Naturethroid or Tyrosint.

But often, regardless of the prescription or the dosage, they still have all the hypothyroid symptoms. And some people are over-medicated so they have hyper symptoms, as well. Like, palpitations, insomnia, tachycardia, anxiety, etc.

And after a while you have to ask: What is going on here?

It’s the same story over and over again. The medications are different, the constellation of symptoms are different, but the basic pattern is the same.

The Problem Is Poor Conversion And Absorption

People are getting plenty of thyroid hormone, but it’s not getting into their cells and having the effect it is supposed to.

If it were, they’d have no hypothyroid symptoms. But virtually everyone does have hypothyroid symptoms.

In this post we examine why thyroid hormone conversion doesn’t happen the way it’s supposed to and what to do about it.

Let’s Review the Physiology

First of all, let’s look at basic physiology. In the body, normally, the thyroid is signaled by the pituitary with TSH (Thyroid Stimulating Hormone). The purpose of this is to goose the thyroid into producing more thyroid hormone.

This occurs because of signals from the body that it needs more. If it’s cold or you need your heart rate to increase, or your metabolism to rev up or you needs to get things moving for sex, etc.

When this happens the thyroid releases T4 (about 97%) and a little bit of T3 (do the math – yup, 3%).

And this is the basic premise of thyroid replacement hormones like Synthroid. It’s synthetic T4. The theory is that you just give it to the patient and tell them to call you in 6 months. An everything should be hunky dory.

In Reality It Doesn’t Work That Way

And the reason it doesn’t work is that thyroid hormone must be converted from T4 into T3 in order for the body to utilize it. This conversion happens differently in different parts of the body.

The problem with TSH only testing to determine thyroid hormone levels in the entire body is that the pituitary, which releases TSH, converts thyroid hormone differently than the rest of the body.

This is why you often see normal TSH with lots of hypothyroid symptoms.

Many doctors, somehow, are ignorant of this fact and instead of truly understanding what is happening physiologically, blame the patient for having symptoms when their lab tests say that they should be fine.

How Does T4 get Converted to T3?

There is an enzyme that is largely responsible for thyroid hormone conversion. It is called 5′ deodinase. And it actually comes in 3 forms: deodinase type I (D1), deodinase type II (D2)and deodinase type III (D3).

D1 and D2 Don’t Behave the Same Way

D1 converts inactive T4 to active T3 throughout the body. In the pituitary, D2 controls this conversion. These two forms behave very differently and are affected by different things.

D1 is suppressed and down-regulated (which means it decreases T4 to T3 conversion and increases reverse T3 levels) in response to stress (both  physiologic and emotional),  depression, dieting, weight gain and leptin resistance, insulin resistance, obesity and diabetes, inflammation from autoimmune disease or systemic illness, chronic fatigue syndrome and fibromyalgia, chronic pain, and exposure to toxins and plastics.

What did we just describe? Your average Hashimoto’s patient living in the modern world! Most people with Hashimoto’s have the majority of conditions mentioned above.

In addition,  D1 activity is also lower in females, making women more prone to tissue or functional hypothyroidism.

Sound familiar? Normal lab results but hypothyroidism at the cellular level.

And when you have these conditions, there are reduced tissue levels of active thyroid hormone in all tissues except the pituitary because D2 does not behave like this, at all.

D2 is 1,000 times more efficient at converting T4 to T3 than D1 in the rest of the body. And it isn’t suppressed and down regulated by any of the things we mentioned.

So TSH is within normal range because the pituitary is getting plenty of thyroid hormone, but the rest of the body is hurtin’ for certain.

D3 and D1 Don’t Play Well Together

D3 converts T4 into reverse T3. There is none of it in the pituitary. D3 also competes with D1. T4 can go either way. It can be converted to T3 which the body can use or into reverse T3 which is not active.

And reverse T3 blocks the effect of T3. It blocks T3 from binding to receptors and when this happens it doesn’t work. So your metabolism slows, and D1 is suppressed so it can’t do it’s job and convert T3 to T4. And D3 blocks T3 and T4 from getting absorbed into cells.

So the result is you have low T3 levels in the cells of your body and you get all the hypothyroid symptoms.

How Do You Fix It?

Like most things related to Hashimoto’s the solution is not simple and it requires a multi-prong approach.

As I have said and written many times, Hashimoto’s is way more than a thyroid problem and way more than a thyroid and autoimmune problem. It is a multi-system disorder that can only be healed using a multi-system approach.

Nowhere is this more evident than in trying to fix poor thyroid hormone conversion.

5 Key Areas for Improving Thyroid Hormone Conversion

There are 5 important areas that need to be assessed and addressed if you want better conversion of T4 to T3.

Let’s break it down:

1. Liver Detoxification and Other Metabolic Pathways

2. Increasing T3 and Lowering Reverse T3 Levels

3. The Gut and Thyroid Hormone Conversion

4. Adrenal Stress Can Cause Lower T3 and Higher Reverse T3

5. Systemic Inflammation Lowers T3

And as a bonus we’ll look at key nutrients that support better thyroid hormone conversion.

Liver Detoxification and Function

In the liver D1 is involved in converting T4 into T3 and selenium is an important part of this process. Reverse T3 is also broken down there.

So having enough selenium is essential. (It is recommend to take from 200 to 400 mcg. (micrograms) per day. Make sure you do not take selenium supplements that contain dairy or gluten based fillers.)

Other important factors that can prevent T4 to T3 conversion include stress (both emotional and physiological), poor nutrition, chronic illness and exposure to heavy metals like cadmium, mercury and lead.

Another important factor is lipid peroxidation and antioxidants in the liver. One of the most important in helping the body deal with the damage caused by these heavy metals and to nourish antioxidant enzyme systems is glutathione.

The best form to take orally is S-Acetyl-L-Glutathione. It can also be taken in liposomal cream form or in an IV.

In addition, there are 2 metabolic pathways in the liver that can have an impact on thyroid hormones. One such pathway is the glucoronidation pathway. This pathway is supported by B vitamins, magnesium, and glysine.

The second is sulfation. Sulfation involves binding things partially broken down in the liver with sulfur containing compounds. It is one of the major detoxification pathways for neurotransmitters, toxins, and hormones (like thyroid hormones).

Vitamin B6 and magnesium are important for sulfur amino acid metabolism, as are foods containing sulfur such as: eggs, meat, poultry, nuts and legumes. (Eggs, nuts and legumes might be a problem if you are on the Autoimmune diet.)

Increasing T3 and Lowering Reverse T3 Levels

Lowering reverse T3 levels and increasing T3 levels is not a simple thing. There are so many variables and other factors that may hinder this process that it’s hard to offer general things that will help.

To really do this properly, one must be tested, evaluated and treated according to what results, symptoms and patterns present themselves.

That being said, let’s look at some general things that may help.

Glucoronidation, mentioned above, has been shown to degrade reverse T3.

The addition of T3 to your thyroid replacement hormone regimen may also be helpful. There are those in the thyroid community that strongly advocate T3 only treatment. Some suggest doing with natural cortisol rhythms, some with time released T3 and others with slow and deliberate increases in T3 therapy.

This may or may not work and what they fail to say is that T3 can also be toxic to the liver in high doses. Again, proper assessment and treatment is required to determine if this course of action is a good idea for you.

Elevations in cortisol, catecholamines, and some cytokines (IL-6, TNF-a, and IFN-a), and low serum albumin levels have also been associated with low T3 syndrome.

The Gut and Thyroid Hormone Conversion

Gut bacteria is important for converting T4 into T3.

About 20 percent of T4 is converted to T3 in the GI tract, in the forms of T3 sulfate (T3S) and triidothyroacetic acid (T3AC). The conversion of T3S and T3AC into active T3 requires an enzyme called intestinal sulfatase.

Intestinal sulfatase comes from healthy gut bacteria. (Sulfur is an important nutrient for this, as well).

When you have an imbalance between good and bad bacteria in the gut, this may significantly reduce the conversion of T3S and T3AC to T3. This is one reason why people with poor gut function may have thyroid symptoms but normal lab results.

Inflammation in the gut also reduces T3 by raising cortisol. Cortisol decreases active T3 levels while increasing levels of inactive T3.

Studies have also shown that cell walls of intestinal bacteria, called lipopolysaccharides (LPS), negatively effect thyroid metabolism in several important ways.

LPS:

•    reduce thyroid hormone levels;

•    dull thyroid hormone receptor sites;

•    increase amounts of reverse T3;

•    decrease TSH; and

•    promote autoimmune thyroid disease (AITD).

 

Adrenal Stress Can Cause Lower T3 and Raise Reverse T3

With stress, cortisol levels often go up. The increased cortisol levels contribute to this disconnect in the body between the TSH and peripheral tissue T3 levels.

Stress reduces T3 levels in the tissues and increases reverse T3 and this results in tissue hypothyroidism and potential weight gain, fatigue, and depression.

This vicious cycle of weight gain, fatigue, and depression that is associated with stress may be prevented with supplementation with timed-released T3 according to some studies.

The reduced immunity from chronic stress has also been thought to be due to excess cortisol production; but the associated reduction in tissue thyroid levels are shown to play a larger role in the decreased immunity seen with stress.

As with stress, treatment with prednisone or other glucocorticoid will suppress D1 and stimulate D3, reducing T4 to T3 conversion and increasing T4 to reverse T3, causing a relative tissue hypothyroidism that is not detected by TSH testing.

This low cellular thyroid level certainly contributes to the weight gain and other associated side-effects with such treatment. Thus, in stressed patients or those treated with corticosteroids, there are reduced tissue T3 levels that are not reflected by the TSH level, making the TSH an inappropriate marker for tissue levels of T3.

So making sure that you have proper levels of DHEA and cortisol is very important.

As is changing the things in your life that cause you stress. With Hashimoto’s we have emptied our stress savings accounts. We have so much physiologic stress that added emotional stress is incredibly destructive. And one area, in particular, is in the impact of stress on tissue levels of T3.

Systemic Inflammation

Hashimoto’s is, at it’s root, a disease of inflammation. And research has found that the inflammatory immune cells (cytokines) and proteins like IL-1, Il-6, C-reactive protein (CRP), and TNF-alpha will significantly decrease D1 activity and reduce tissue T3 levels. Any person with an inflammatory condition – Hashimoto’s – will have a decreased T4 to T3 conversion in the body and a relative tissue hypothyroidism.

These immune proteins will, however, increase the activity of D2 and suppress the TSH despite reduced peripheral T3 levels; again, making a normal TSH an unreliable indicator of normal tissue thyroid levels.

There is also a direct inverse correlation between CRP and reduced tissue T3, so individuals with elevated CRP (greater than 3 mg/l) or other inflammatory cytokines may have a significant reduction in cellular T3 levels.

The suppression of T3 levels inside the cells is linked with the degree of elevation of CRP, despite serum thyroid tests being “normal”.

So, if any inflammation is present,  the body will have lower T3 levels in the cells and this can impact function; but the pituitary will have increased levels of T3, resulting in a lowering of the TSH so that, once again test results appear normal. (Have I made this point enough times?)

This really emphasizes the importance of anti-inflammatory strategies to improve T3 levels in the tissues. Anti-inflammatories like Turmeric, ginger, resveratrol, glutathione, and Vitamin D are all helpful.

Sometimes these are needed in rather high dosages.

Eliminating foods that cause inflammation is also absolutely critical: gluten, dairy, soy, sugar, alcohol, processed foods, pesticides and chemical additives should all be strictly eliminated.

The Autoimmune Paleo approach is an excellent diet for reducing systemic inflammation and increasing tissue T3 levels.

Other Helpful Herbs and Supplements to Support Conversion

Commiphora muku guggulu (Myrrh resin) Guggul produces a resinous sap known as gum guggul. The extract of this gum, called gugulipid, guggulipid or guglipid, has been used in Ayurvedic medicine, a for nearly 3,000 years in India. The active ingredient in the extract is the steroid guggulsterone. This has been shown to stimulate healthy synthesis of T3.

Selenium is a major cofactor for the enzyme 5′ deiodinase which is responsible for converting T4 into T3 as well as degrading reverse T3.

Low zinc status has been shown to compromise T3 production. Zinc can improve thyroid hormone production and play a role in reducing antibodies.

Lipid peroxidation and antioxidant enzyme systems have been shown to play a profound role peripheral thyroid hormone conversion. Glutathione is extremely effective in supporting peroxidation.

Lastly, it is essential to work with someone who understands the complexity of this situation and who can evaluate what is going on properly and who can determine which course of action and combination of things may be best for you.

 

References:

http://nahypothyroidism.org/deiodinases/

http://www.aaqm.org/Downloads/doc-qmuAUG08.pdf

http://www.chiro.org/nutrition/FULL/Peripheral_Metabolism_of_Thyroid.html

Bianco AC, Salvatore D, Gereben B, Berry MJ, Larsen PR. Biochemistry, Cellular and Molecular Biology, and Physiological Roles of the Iodothyronine Selenodeiodinases Endocrine Reviews 2002;23 (1):38-89.

Koenig RJ, Leonard JL, Senator D, Rappaport N, Regulation of thyroxine 5’-deiodinase activity by 3,5,3’-triiodothyronine in cultured rat anterior pituitary cells. Endocrinology 1984;115(1):324-329.

Silva JE, Dick TE, Larsen PR. The contribution of local tissue thyroxine monodeiodination to the nuclear 3,5,3’-triiodothyroinine in pituitary, liver and kidney of euthyroid rats. Endocrinology 1978;103:1196. location of D2

Kaplan MM. The Role of Thyroid Hormone Deiodination in the Regulation of Hypothalamo-Pituitary Function Progress in Neuroendocrinology. Neuroendocrinology 1984;38:254-260.

Peeters RP, Geyten SV, Wouters PJ, et al. Tissue thyroid hormone levels in critical illness. J Clin Endocrinol Metab 2005;12:6498–507.

Bartelena L, Brogioni S, Grasso L, et al. Relationship of the increased serum interleukin-6 concentration to changes of thyroidal function in nonthyroidal illness. J Endocrinol Invest 1994;17:269-274.

St Germain DL, Galton VA. The deiodinase family of selenoproteins. Thyroid 1997;7:655-668.

Moreno M, Berry MJ, Horst C, et al. Activation and inactivation of thyroid hormone by type I iodothyronine deiodinase. FEBS Lett 1994;344:143-146.

Gupta P, Kar A. Cadmium induced thyroid dysfunction in chicken: hepatic type I iodothyronine 5′-monodeiodinase activity and role of lipid peroxidation. Comp Biochem Physiol C Pharmacol Toxicol Endocrinol 1999;123:39-44.

Chaurasia SS, Kar A. Protective effects of vitamin E against lead-induced deterioration of membrane associated type-I iodothyronine 5′-monodeiodinase (5’D-I) activity in male mice. Toxicology 1997;124:203-209.

Barregard L, Lindstedt G, Schutz A, Sallsten G. Endocrine function in mercury exposed chloralkali workers. Occup Environ Med 1994;51:536-540.

Brzezinska-Slebodzinska E, Pietras B. The protective role of some antioxidants and scavengers on the free radicals-induced inhibition of the liver iodothyronine 5′-monodeiodinase activity and thiols content. J Physiol Pharmacol 1997;48:451-459.

Visser TJ, Kaptein E, van Toor H, et al. Glucuronidation of thyroid hormone in rat liver: effects of in vivo treatment with microsomal enzyme inducers and in vitro assay conditions. Endocrinology 1993;133:2177-2186.

Visser TJ, Kaptein E, van Raaij JA, et al. Multiple UDP-glucuronyltransferases for the glucuronidation of thyroid hormone with preference for 3,3′,5′-triiodothyronine (reverse T3). FEBS Lett 1993;315:65-68.

Gueraud F, Paris A. Glucuronidation: a dual control. Gen Pharmacol 1998;31:683-688.

Wyatt I, Coutts CT, Elcombe CR. The effect of chlorinated paraffins on hepatic enzymes and thyroid hormones. Toxicology 1993;77:81-90.

van Raaij JA, Kaptein E, Visser TJ, van den Berg KJ. Increased glucuronidation of thyroid hormone in hexachlorobenzene-treated rats. Biochem Pharmacol 1993;45:627-631.

Kester MH, Kaptein E, Roest TJ, et al. Characterization of human iodothyronine sulfotransferases. J Clin Endocrinol Metab 1999;84:1357-1364.

Visser TJ. Role of sulfation in thyroid hormone metabolism. Chem Biol Interact 1994;92:293-303.

Schuur AG, Brouwer A, Bergman A, et al. Inhibition of thyroid hormone sulfation by hydroxylated metabolites of polychlorinated biphenyls. Chem Biol Interact 1998;109:293-297.

Visser TJ, Kaptein E, Glatt H, et al. Characterization of thyroid hormone sulfotransferases. Chem Biol Interact 1998;109:279-291 .

Wu SY, Huang WS, Chopra IJ, et al. Sulfation pathway of thyroid hormone metabolism in selenium-deficient male rats. Am J Physiol 1995;268:E572-E579.

Kaptein E, van Haasteren GA, Linkels E, et al. Characterization of iodothyronine sulfotransferase activity in rat liver. Endocrinology 1997;138:5136-5143.

Panda S, Kar A. Gugulu (Commiphora mukul) induces triiodothyronine production: possible involvement of lipid peroxidation. Life Sci 1999;65:PL137-141.

Panda S, Kar A. Changes in thyroid hormone concentrations after administration of ashwagandha root extract to adult male mice. J Pharm Pharmacol 1998;50:1065-1068.

Burger AG, Engler D, Sakoloff C, Staeheli V. The effects of tetraiodothyroacetic and triiodothyroacetic acids on thyroid function in euthyroid and hyperthyroid subjects. Acta Endocrinol (Copenh) 1979;92:455-467.

Arthur JR, Nicol F, Beckett GJ. Selenium deficiency, thyroid hormone metabolism, and thyroid hormone deiodinases. Am J Clin Nutr 1993;57:236S-239S.

Kralik A, Eder K, Kirchgessner M. Influence of zinc and selenium deficiency on parameters relating to thyroid hormone metabolism. Horm Metab Res 1996;28:223-226.

Olivieri O, Girelli D, Stanzial AM, et al. Selenium, zinc, and thyroid hormones in healthy subjects: low T3/T4 ratio in the elderly is related to impaired selenium status. Biol Trace Elem Res 1996;51:31-41.

Olivieri O, Girelli D, Azzini M, et al. Low selenium status in the elderly influences thyroid hormones. Clin Sci (Colch) 1995;89:637-642.

Strain JJ, Bokje E, van’t Veer P, et al. Thyroid hormones and selenium status in breast cancer. Nutr Cancer 1997;27:48-52.

Calomme M, Vanderpas J, Francois B, et al. Effects of selenium supplementation on thyroid hormone metabolism in phenylketonuria subjects on a phenylalanine restricted diet. Biol Trace Elem Res 1995;47:349-353.

Fujimoto S, Indo Y, Higashi A, et al. Conversion of thyroxine into tri-iodothyronine in zinc deficient rat liver. J Pediatr Gastroenterol Nutr 1986;5:799-805.

Nishiyama S, Futagoishi-Suginohara Y, Matsukura M, et al. Zinc supplementation alters thyroid hormone metabolism in disabled patients with zinc deficiency. J Am Coll Nutr 1994;13:62-67.

Kuang AK, Chen JL, Chen MD. Effects of yang-restoring herb medicines on the levels of plasma corticosterone, testosterone and triiodothyronine. Chung Hsi I Chieh Ho Tsa Chih 1989;9:737-778, 710. [Article in Chinese]

Winterhoff H, Gumbinger HG, Vahlensieck U, et al. Endocrine effects of Lycopus europaeus L. following oral application. Arzneimittelforschung 1994;44:41-45.

Winterhoff H, Sourgens H, Kemper FH. Antihormonal effects of plant extracts. Pharmacodynamic effects of lithospermum officinale on the thyroid gland of rats; comparison with the effects of iodide. Horm Metab Res 1983;15:503-507.

Tahiliani P, Kar A. Role of moringa oleifera leaf extract in the regulation of thyroid hormone status in adult male and female rats. Pharmacol Res 2000;41:319-323.

Forsythe WA 3rd. Soy protein, thyroid regulation and cholesterol metabolism. J Nutr 1995;125:619S-623S.

Potter SM, Pertile J, Berber-Jimenez MD. Soy protein concentrate and isolated soy protein similarly lower blood serum cholesterol but differently affect thyroid hormones in hamsters. J Nutr 1996;126:2007-2011.

Hashimoto’s Health Tip: Pesticides and Hypothyroidism

Produce with Highest Levels of Pesticides

One of my favorite organizations, the Environmental Working Group, released their 2014 list of produce with highest amount of pesticides.

This is a real concern for those of us with Hashimoto’s and hypothyroidism because studies have linked pesticide concentrations with a significant increase in thyroid disease. 

Link Between Thyroid Disease and Pesticides
One study (see the link below) looked at the prevalence of thyroid disease in spouses of pesticide applicators (people who work on farms and applied them.)

They found an association of organochlorines and fungicides with hypothyroidism. And a 12.5% higher increase in thyroid disease than in the general population.

According to the study “Exposure to these classes of pesticides and thyroid dysfunction is plausible given that the main effects of these compounds are thought to be elevation of TSH levels and reduction of circulating thyroid hormone (T3 and T4).”

An Apple A Day Doesn’t Keep The Doctor Away Anymore

Nonorganic apples once again topped The EWG’s Shopper’s Guide to Pesticides in Produce report, making it the fourth year in a row that the fruit that has the reputation of keeping the doctor away, may now be having the opposite effect thanks to better living through chemistry.

Kale, collard greens, and hot peppers were frequently contaminated with insecticides that are particularly toxic to human health, prompting their “Dirty Dozen Plus” status.

The moral of the story? Grow your own in an organic garden and/or buy organic at your local farmer’s market.

The 2014 “Dirty Dozen”

1. Apples
2. Strawberries
3. Grapes
4. Celery
5. Peaches
6. Spinach
7. Sweet Bell Peppers
8. Nectarines (Imported)
9. Cucumbers
10. Cherry Tomatoes
11. Snap Peas (Imported)
12. Potatoes
+ Hot Peppers
+ Kale/Collard Greens

2014 “Clean 15”

It’s not all bad news! This produce contained the lowest pesticide levels.

1. Avocados
2. Sweet Corn
3. Pineapples
4. Cabbage
5. Sweet Peas (Frozen)
6. Onions
7. Asparagus
8. Mangoes
9. Papayas
10. Kiwi
11. Eggplant
12. Grapefruit
13. Cantaloupe
14. Cauliflower
15. Sweet Potatoes

Reference:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842196/

Today’s Hashimoment: How to Build Resilience

Resilience is Key to Overcoming Setbacks

One of the biggest challenges about living with Hashimoto’s is that there can be many set backs.

And if you do not have the ability to bounce back quickly and be resilient, then this may compound your suffering.

Because if you have multiple setbacks, one after the other, and you are still having trouble getting over the first, then you can become mired in gloom, despair and defeat.

Practice Mindfulness and Detachment

One of the best ways to develop resilience is to practice mindfulness and detachment. The more you strengthen your detachment muscles, the easier it is to bounce back.

Detachment allows you to view your emotions from a bit of a distance.

This way you can see that feelings are not facts and emotions are not emergencies. They are just feelings and emotions and they come and go.

And you have a choice about how much importance you are going to give them. It’s all about your perception of them.

Meditation Can Develop Detachment

A great practice for developing detachment is meditation. Simply sitting, breathing and observing your thoughts.

Even as little as 5 minutes per day can help you develop the ability to observe your mind.

And as you watch it, you will observe thoughts and emotions rush in. Instead of holding onto them, return to your breath or to observing something in your physical body and let those thoughts and emotions go.

It can be challenging at first, but it gets easier.

Get Yourself Free

And once you get a glimpse of the world outside of attachment to these feelings, thoughts and emotions you realize what a prisoner you can be to them.

Getting some degree of freedom from them can have a big impact on our ability to heal.

Sit, breathe and let go.

Please share with us your thoughts, experiences or tricks for finding detachment.

Hashimoto’s Health Tip: Stress Is Not Your Friend

Did you know that low thyroid function is often caused by some other condition first, and often adrenal gland stress is the culprit?

Chronic adrenal stress can:

* Affect communication between the brain and glands that produce hormones. The hypothalamus and pituitary gland are the directors of hormone production and chronic adrenal stress can mess up communication with the thyroid.

* Increase thyroid binding activity, keeping thyroid hormones from getting absorbed by the cells of the body.

* Interfere with the conversion of T4 to active forms of T3 that the body can use.

* Affect detoxification pathways that clear out unnecessary thyroid hormone, when these get stuck in the body you can develop thyroid hormone resistance making cells lose their sensitivity to thyroid hormones.

* Weakens the immune barriers of the gut, lungs, and brain and weaken the immune system, in general.

When this happens, you can have more immune flare ups and this can trigger your Hashimoto’s and make it worse.

So, what are doing about stress?

Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else.

These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten, dairy and soy), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.

Sound familiar?

These are also all the things that make Hashimoto’s worse.

We can’t ignore them or pretend like they aren’t there like so many doctors do. We have to deal with all of them.

Here’s the thing, we have maxed out our stress cards (like our credit cards for stress).

With Hashimoto’s your body is under so much physiological stress, all the time, that extra emotional stress will often totally wipe you out.

This happens because we’ve emptied our accounts and now we have to reinvent our lives and this means what you do everyday.

We have to start putting relaxation and fun back into our “stress savings” accounts.

Seriously, you have to replenish this account. It’s not enough to say “Yeah, I have nothing in that account.”

Because just like your bank account if you aren’t putting money back in and you’re always just taking money out, what happens?

Eventually, you go broke and you got all these creditors after you and lose your house and your car and eventually, you wind up on the street.

Talked about stressed out!

That’s what’s happening in your body. You wind up with the functional equivalent of being homeless inside your own body.

Here are 5 common mistakes people make when dealing with stress in their day to day lives.

And, really, we have plenty of opportunities to take positive actions regarding stress every day, and often these wind up being missed opportunities and actually lead to more stress.

Here are 5 common mistakes people make every day dealing with stress.

The most important thing you can do is start becoming aware of this.

Are you…

1. Working through lunch (or other meals)?

This is a really common problem. many people don’t take the time to relax and enjoy their meals. This is a huge opportunity to relax and if you are stressed during your meal, it has a big impact on your digestion and absorption of food and vital nutrients.

2. Using your break time to vent and complain?

What you focus on is what becomes reality. Put that energy into manifesting something positive, like healing.

Go for a walk, appreciate the things around you instead.

3. Doing too many things at once?

Try slowing down and doing one thing at a time. So many people spend their days multi-tasking themselves into a totally stressed out state of mind (and body).

4. Not asking for help?

How often do we let our pride stop us from asking for help when we really need it? There’s no shame in admitting you need help and reaching out to someone and asking.

5. Denying there’s a problem?

So many people pretend they have stress under control when they really don’t, at all.

It is a very powerful trigger of autoimmunity. It can completely torpedo your progress.

You can’t just pretend it’s not here.

It’s here and it’s here to stay, so you need effective strategies for having less of it.

Every day.

Please share with us your best stress relieving practices.

Hashimoto’s Health Tip: Remission

In today’s health tip, I’d like to talk about remission from Hashimoto’s.

Remission should be the goal for all of us. We should all strive to get Hashimoto’s to a place that can allow us to have our lives back.

And we should all work hard to stop the progression and the proliferation of the underlying autoimmune process.
The stakes of not doing this are just too high.

But how do you define remission? And what happens when you get there?

The problem with focusing on this as a goal is that this implies that once we reach it, we’re done.

And this begs the question: How do we know when we get there?

One way that some people define remission is normal blood work including normal or undetectable antibodies.

There are several problems with this.

Many, many people have normal blood test results and feel awful.

And antibody numbers are not static, they are changing all the time. Getting them into a normal range is not a guarantee that they will stay there.

And there are lots of reasons why blood tests can look normal and you can still feel terrible. The immune system can release TSH and thyroid hormones all by itself, and this can throw off your results and make them less meaningful.

Also, your pituitary absorbs thyroid hormone differently than the cells in the rest of your body, so it may be getting enough thyroid hormone while the rest of your body is not.

Again making your blood test results less meaningful.

So, blood test results aren’t a great measure of success. As I have said repeatedly, how you feel, on the other hand, is diagnostically important and clinically relevant with Hashimoto’s.

This is actually a really important measure of success.

And the other problem with viewing remission as an end point is that if we do get there, it is a natural tendency to get complacent and to just go back to the same old behavior and diet that contributed to you being sick in the first place.

That’s just human nature.

So, I invite you to see remission as a journey and not as a destination. And to view it as a path and not a place you reach.

If you think about it his way, it involves a higher level of acceptance and commitment. Because it’s not conditional and it’s not something you’re ever finished with.

Remission is an ever evolving journey and if you are committed and vigilant and open to the possibilities of personal growth and transformation then it becomes like a kind of garden that just keeps rewarding you with new gifts.

Because here’s the other thing, you never know how good it could be and if you just settle for normal blood test results, then you might be putting a cap on this that stops you from going to a much higher place.

The possibilities are endless, people, when you think of it this way.

What we need to do is to create a lifestyle that supports healing and remission every single day. And strive to do that at every opportunity.

That’s a whole different ball game.

What are your thoughts on this? Please share them with us.

Hashimoto’s Health Tip: Glyphosates and Gluten

Yet Another Reason Gluten Is Not Your Friend

A recent study published in the the Journal of Interdisciplinary Toxicology (Vol. 6(4): 159–184. by Anthony Samsel and Stephanie Seneff looks at the health impact on glyphosates, the main ingredient in Monsanto’s marquee product Roundup.

This is a popular herbicide used for many purposes including domination of the world’s seed supply.

Here what they found.

This stuff is everywhere and it is used by farmers on wheat crops 2-3 days before harvesting to dry everything out and make it easier to harvest.

Wheat Is Soaked With This Chemical

Why let it dry in the sun when you can spray it with toxic chemicals?

This is now also used on all grain crops, rice, seeds, dried beans and peas, sugar cane, sweet potatoes, and sugar beets.

It is also used on genetically modified crops like corn and soy, extensively.

Well, it turns out that glyphosate is a known endocrine disruptor, not good news for all us thyroid hormone fans and it has a lot of other really bad effects on our bodies.

Samsel & Seneff have carefully researched the known (published) effects of glyphosate along with the known (published) pathologies associated with celiac disease, gluten intolerance and irritable bowel syndrome.

They have identified chemical and biological pathways where glyphosate can be the cause.

Roundup Has Been Linked to Many Health Problems

These are: disruption of the gut bacteria; breakdown in the junctions of the intestinal wall; depletion of vital minerals, vitamins and nutrients; and impairment of cytochrome enzymes that aid the liver in detoxifying environmental toxins, thus multiplying the negative effect of other environmental toxins to which we are exposed in increasing amounts.

Translation: Glyphosate may lead to leaky gut, which allows glyphosate soaked gluten to get into your blood stream and your brain, where it does major damage.

This begs the question, is the problem gluten or Roundup?

The answer for you and me?

It doesn’t matter, because they are now one in the same. Go 100% gluten free people.

It’s just not worth the damage it causes.

http://sustainablepulse.com/wp-content/uploads/2014/02/Glyphosate_II_Samsel-Seneff.pdf

Today’s Hashimoment: Living in the Moment

Hashimoments are affirmations and positive thoughts for people with Hashimoto’s. I started to write them because after reading research on the role of stress and emotions on the immune system, I realized how important what you think about and how you feel can be for your health.

I think one of the most challenging things about having Hashimoto’s is having to accept that there is no end point in dealing with this disease.

We can make tremendous progress in getting it under control or, hopefully, in remission. However, keeping it there requires daily commitment, discipline and vigilance.

And when you slip up, you pay.

And (forgive my language) sometimes the payment puts you on your ass and you are reminded, painfully, of what you can not do.

The point I’m trying to make is that this is a journey and while you make stops along the way, like any trip, you’ll never arrive at that place with no consequences.

Everything You Do Has Consequences

This is true of regular life, but it is especially true with Hashimoto’s.

What you do has special importance because of the challenges your body already faces.

What you eat, what you think, how much stress you have, what you drink, you name it, it all matters.

So, we’re faced with how we experience this.

It’s All About the Way You Look at It

Is it a crushing defeat or an incredible blessing?

This is the very definition of living in the moment.

This is what many saints and mystics strive for. Something to keep them present. What they often add is the element of detachment. That is their goal, to be present in every moment but to not be attached to that moment.

Be conscious of the decisions you make. Live in the now. Make those decisions count.

Because whether you like it or not, they will anyway.

 

Hashimoto’s Health Tip: Artificial Sweeteners

Diet soda and other products that contain sugar substitutes can have a harmful effect on the thyroid.

The issue here, in my opinion, is the conversion of artificial sweeteners, like aspartame, into formaldehyde. Like many environmental toxins, this causes inflammation and an immune response.

A case report presented at the American Association of Clinical Endocrinologists (AACE) 22nd Annual Scientific and Clinical Congress. Issac Sachmechi, M.D., F.A.C.E., F.A.C.P., of New Hyde Park, New York, treated a patient diagnosed with Hashimoto’s thyroiditis that resolved completely with the elimination of artificial sweeteners including Sweet’N Low, Equal, SPLENDA®, and diet sodas.

“An overabundance of sugar-substituted beverages could pose a serious health risk if you are a thyroid patient,” says Dr. Sachmechi. “While the issue is being studied more in-depth, thyroid patients should manage their intake of sugar substitutes while consulting their endocrinologist,” he adds.

Formaldehyde, widely known as an embalming fluid, is a by product of the breakdown of aspartame in the liver and may be associated with immune system disorders.

Your Body Can’t Clear These Toxins Normally

It is important to understand how the body clears environmental toxins, pollutants, and chemicals. In our bodies this happens primarily in the liver.

However, although the liver has hundreds of enzymes to clear many compounds, it still does not have enough to clear everything out of your body. And, unfortunately, many of the most common and most toxic environmental compounds can not be cleared by the liver.

What Happens When the Liver Doesn’t Clear These Toxins, Pollutants and Chemicals?

They become lodged in the body and activate inflammation and disrupt the immune system. This can lead to chronic pain and inflammation, cancer growth and autoimmunity.

Recent research has led us to discover several important ways that your body deals with exposure to these toxins.

Toxic Chemicals Affect the Body in the Following Ways

1. They deplete glutathione.

2. They initiate inflammation, cancer and auto-immune disease through a signaling system in your DNA called NF-Kappa B.

3. They clog your liver and make the liver work harder at clearing toxins and they make liver detoxification not work as well.

4. They cause leaky gut syndrome.

5. They lead to loss of chemical tolerance and multiple food allergies and sensitivities to chemicals, smells and things that never used to bother you (which some researchers think may be the beginning of auto-immune disease).

The unintended consequences of better living through chemistry, people.

Hashimoto’s Health Tip: Low Thyroid Function

Did you know that low thyroid function is often caused by some other condition first, and often adrenal gland stress and blood sugar problems are the culprits?

Translation? High sugar, high caffeine beverages (coffee drinks, energy drinks, etc.). These stimulate the adrenal stress response and cause serious blood sugar imbalances.

Chronic Adrenal Stress Can:

* Affect communication between the brain and glands that produce hormones. The hypothalamus and pituitary gland are the directors of hormone production and chronic adrenal stress can mess up communication with the thyroid.

* Increase thyroid binding activity, keeping thyroid hormones from getting absorbed by the cells of the body.

* Interfere with the conversion of T4 to active forms of T3 that the body can use.

* Affect detoxification pathways that clear out unnecessary thyroid hormone, when these get stuck in the body you can develop thyroid hormone resistance making cells lose their sensitivity to thyroid hormones.

* Weaken the immune barriers of the gut, lungs, and brain and weaken the immune system, in general. When this happens, you can have more immune flare ups and this can trigger your Hashimoto’s and make it worse.

Blood Sugar Imbalances Can:

Cause cortisol to be released to try to restore blood sugar balance (see the connection between the adrenals and blood sugar?)

* Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3.  This can lead to low T3 levels.

* In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells.

* Cortisol will also increase the production of reverse T3 (rT3) which is inactive.  (It’s kind of like the anti-hormone.)

* rT3 can cause an increase in the production of substances known as thyronamines that can cause hypothyroid symptoms (like, low basal body temperature,fatigue, depression, etc.) along with insulin resistance symptoms of increased blood sugar.

* Cortisol can also lower the levels of protein that binds to thyroid hormone so it can circulate in a stable structure.

* And finally, elevated cortisol will slow TSH production by messing with hypothalamic-pituitary feedback leading to lower TSH production.

So put down that frozen frappuccino hypothyroid drink and your thyroid will thank you!

Thyroid Replacement Hormone: The Wrong Obsession?

Some of the most common questions I receive via phone, email, Facebook, and yelled across the street concern thyroid replacement hormone.

The question usually goes something like, “Hey, what’s the best thyroid hormone?”

And like most things with Hashimoto’s, this is a super difficult, complicated question disguised as a simple one.

All I can do is mumble, “It depends”

Thyroid Replacement Hormone Often Doesn’t Help You Feel Better

In addition, the problem is that, in reality, many, many people don’t feel better after taking thyroid replacement hormone.

Or they feel better for a while, then they feel worse again.

And a lot of Hashimoto’s patients get fixated on this drug.

Some have to change to natural desiccated. Some are told they have to get on a synthetic. Others have to add T3 or only be on T3. Or they have to raise the dosage, then lower it, then change to something else.

And doctors also share this fixation because thyroid hormone is really important physiologically and for most, thyroid replacement hormone is the only tool in their tool box. And many refuse to budge from the myth that synthetic T4 is the only safe option.

So we wind up with dueling and intractable obsessions resulting in people being pissed off at their doctors, doctors refusing to prescribe anything except Synthroid or the generic equivalent and, unfortunately for the patient, little or no improvement in their hypothyroid symptoms.

There has got to be a better way.

In this post, we will look past this obsession and help break down and demystify thyroid replacement hormone.

Do You Really Need It At All?

The first question, and one that is controversial, is do you really need to be on thyroid replacement hormone?

This is an important question and, of course, the answer is….(wait for it)…it depends.

On what?

Really, it depends on how much thyroid function you have left.

Hashimoto’s is an autoimmune disease in which your immune system slowly destroys your thyroid.

If enough of your thyroid gets destroyed and it stops producing sufficient amounts of thyroid hormone, you can not be without replacement hormone. End of conversation.

On the other hand, if you do have enough thyroid function (and a lot of people do), then the problem may lie elsewhere.

You May Not Need It

Often the problem is an out of control immune system impacting thyroid function or problems with breakdowns in thyroid pathways that are causing the hypothyroidism.

It’s not the lack of thyroid replacement hormone.

If you focus on properly managing the autoimmune disease part of the equation and on properly evaluating and improving the pathways that make thyroid hormone work, then you may not need extra thyroid hormone at all.

(To complicate matters, once you start taking replacement hormone it impacts the amount of thyroid hormone your body is producing.

So if you have been on it for many years, chances are you may have compromised the thyroid’s ability to produce it alone.)

You Always Must Address the Autoimmunity

Even when thyroid hormone replacement is used, it is still very important to manage the autoimmune condition.

This will make the medication work better, slow the destruction of the thyroid gland, and prevent the progression of the autoimmune condition into attacks on other parts of the body like the brain, which comes in really handy, at times.

This is where we should really be fixated. Slowing or stopping the progression of the autoimmune part of this disease should be our obsession. (Ok, I admit it, it’s mine.)

Let’s Look At The Options

That being said, let’s take a look at what the options are and how you can make the best decision for you and your unique set of circumstances.

First there are 2 important factors to consider:

* Bio-identical versus Synthetic

* T3

Bio-identical Versus Synthetic

Bio-identical, as the name suggests, is more like what your body actually produces. The most popular of these are Armour or Nature-throid. The advantage to these is that we can actually test their levels in your system using laboratory testing other than TSH.

The disadvantage is that some people with Hashimoto’s will feel worse on these because their immune system can attack T3 and T4 because they actually have antibodies against them.

Unfortunately, we do not yet have laboratory tests available to test these antibodies.

The advantage of synthetic drugs like Synthroid and levothyroxine is that they are synthetic and the immune system will not attack them.

The disadvantage is that TSH is the only test to measure levels of these drugs and there are many reasons why TSH is an unreliable marker of thyroid hormone levels.

The criticism by doctors leveled against bio-identical hormones is that the dosage varies from batch to batch. A frequently perpetuated myth (from the marketers of Synthroid) is that the dosages and ratio of T4:T3 in Armour aren’t consistent.

That’s just not true, studies have shown otherwise. Armour contains a consistent dose of 38 mcg T4 and 9 mcg T3 in a ratio of 4.22:1. As does Nature-throid.

T3 to the Rescue

Many patient advocates and thyroid support groups sing the praises of T3. And for some, there is no question, T3 is the answer. For others, it’s a nightmare.

T3 is the active form of thyroid hormone, this is what has the greatest impact on our bodies. This is what gives you energy, gets the bowels moving, makes you feel happier and helps you think more clearly. For some this is what helps their hair grow better and their skin get that blood flow back into it.

These people may have trouble converting T4 to T3 because their cells develop thyroid hormone resistance.

On the other side of this are the people who get hyperthyroid with the addition of T3. Think anxiety, insomnia, palpitations, weirdness, a strong desire to vacation at the funny farm.

This is also the case with people who are not managing the autoimmune part of this disease. The attacks against the thyroid causes more thyroid hormone to be released into the bloodstream.

For these people, synthetic T4 might be the better choice along with a concerted focus on managing the causes of these inflammatory incidents (like eliminating gluten, dairy, soy, stress and environmental toxins).

2 Common Things Make You Feel Worse

There are also 2 important factors that can make you feel much worse on thyroid replacement hormone:

Fillers and Adrenal Issues.

Fillers: These are extra things added to the drugs by the manufacturers. Many popular thyroid medications contain common allergens such as cornstarch, lactose and, in some cases, even gluten.

Most Hashimoto’s patients have issues with gluten, and many of them also react to corn and dairy (which contains lactose).

Synthroid has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler.

Even the natural porcine products like Armour use fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler.

This was great for some patients who were sensitive to dextrose and a disaster for others who were sensitive to the methylcellulose.

Nature-throid is considered the most hypo-allergenic of the bio-identicals.

The best choice may be to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to. This can be more expensive and unfortunately, some insurance companies refuse to cover it.

Adrenal Issues: If you take Synthroid or even a bio-identical and feel so horrible on the drug that you just can’t continue taking it, one thing to check right away is your adrenals.

The warning label of Synthroid states explicity “Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.”

This can cause an acute adrenal crisis in the most extreme cases.

But even in less extreme cases, like those people who have adrenal fatigue and/or exhaustion, taking this drug can result in the patient feeling really lousy.

The adrenals should always be evaluated whenever a patient is prescribed thyroid replacement hormone. (Ideally, this should happen before it is prescribed. Good luck with that.)

Other Common Scenarios

Let’s take a look at some other common clinical situations and look at why these things happen.

Normal TSH, But Still Feel Like Crap

This is by far the most common scenario for people with Hashimoto’s. Chronic inflammation can prevent thyroid hormone from getting absorbed in to the cells of the body. This the root of autoimmune disease, but can also come from other things (like infections, surgery, obesity, overtraining, poor diet, etc.).

This can:

*Inhibit thyroid receptors on cells from responding to thyroid hormone.

*Prevent T4 from converting to T3.

*Interfere with the communication between the pituitary and the thyroid (and the adrenals).

Felt Better With Bio-Identical

Some people truly do feel better with bio-identicals. It’s not true of everyone but the addition of T3 can sometimes be the answer because these people:

*May need T3 due to problems with the thyroid hormone receptors on cells

* Were unable to convert T4 to T3 when using T4-only medication

*Had sensitivities to dyes or fillers in synthetic compounds that are not in bio-identical compounds

*Have receptor sites on cells that simply respond better to bio-identical than synthetic hormones

Did Better With T3 Only

As we have seen, some people improve with the addition of T3, while others do their best with T3 only. And these can be synthetic or bio-identical.

This can happen for a couple of reasons:

* Their receptor sites are resistant to thyroid hormone because of high cortisol, high homocysteine, inflammation, low progesterone, vitamin A deficiency and more.

* Difficulty in converting T4 to T3

Didn’t Feel Better With T3 or Bio-identical Hormones

In both cases, more T3 is introduced. These people often don’t have too little T3, they have an active and uncontrolled autoimmune process causing the release of thyroid hormone.

These are also the people who often vacillate from hyper to hypo. They have an immune flare up, more hormone is released and then they crash, it calms done and they are hypo again.

In some cases, these people can have excess adrenal hormones caused by too much nicotine, caffeine, stress or exercising too much.

Feel Better on Synthetic Hormones

Some people actually feel better on synthetic hormones. These can be people who are converting well, have an overactive metabolism and just don’t need more T3.

These are people who also really benefit from an approach that will calm the autoimmune attacks that cause their thyroid to be revved up in the first place.

Bottom Line:

In every single case described above addressing the underlying autoimmune process first will result in a better clinical outcome (you will feel better) because by reducing the inflammation which is the root of this problem you can:

Improve thyroid receptor site sensitivity

Prevent further destruction of the thyroid

Slow the progression of the autoimmune disease so it doesn’t spread to other parts of the body.

Once again, there are so many variables with Hashimoto’s. The best approach involves a full thyroid work-up and exam, followed by trial and error of different types of replacement medications.

Such a work-up includes more than just TSH, it also has a more complete thyroid panel (including antibodies), other important blood markers (glucose, lipids, CBC with diff, electrolytes, iron, etc.) and additional inflammatory markers like homocysteine, vitamin D, CRP, ferritin, etc.

A history must be taken with attention paid to the patient’s past responses to replacement hormones. With Hashimoto’s patients what a patient feels is clinically relevant and diagnostically important.

Unfortunately, this rarely happens in the conventional model, where the standard of care is to test only for TSH and, if you’re lucky T4.

If TSH is elevated, the patient will get whatever hormone that particular doctor or practitioner is fond of prescribing and that’s the end of it.

Then they are told, “Come back in 6 months to a year and get your TSH tested again. Buh bye.”

And all too often, as many of you know, this approach is doomed to failure. But there is a better way and we are practicing it here at Hashimoto’s Healing.

We offer a complete work up and we focus…, ok, I’ll say it…rather obsessively on reducing the inflammation at the root of this disease and at doing other things to calm, slow and prevent the advancement of autoimmunity to other parts of your body.

This is not just a thyroid problem and there is a lot at stake here. If we’re going to be obsessive, let’s obsess about the things that are at the root of the problem.

Want Someone To talk To About This?

I set aside time every week to talk to people with Hashimoto’s about what’s going on with them. In the last year, I have had over 500 of these conversations.

I offer a free 30 minute Hashimoto’s Healing Discovery Session.

In it you can share where you are and where you want to be, I can give you some advice that will help right away and we can discuss how else I may be able to get you feeling better.

If you want to talk with someone who gets it, someone who has been there and who has devoted his life to help people with Hashimoto’s, then I suggest you schedule a time to chat with me.

You might just learn something. Here’s the link to schedule.

References:

http://www.ncbi.nlm.nih.gov/pubmed/23072197 T3 to T4 ratios

http://www.womensinternational.com/pdf/thyroid_hormone_therapy_options.pdf T3 to T4 ratios

http://www.medscape.com/viewarticle/722086_1 Full on medical discussion

http://www.ncbi.nlm.nih.gov/pubmed/15767619 Interesting study on the difference additional T3 therapy makes

http://chriskresser.com/3-steps-to-choosing-the-right-thyroid-hormone

http://thyroidbook.com/blog/which-thyroid-hormone-is-right-for-you/

http://www.rxlist.com/synthroid-drug.htm

http://www.rxlist.com/armour-thyroid-drug.htm

http://www.rxlist.com/cytomel-drug.htm

http://www.nature-throid.com/what_is_nature_throid.php

http://tpauk.com/main/?page_id=1054 Argument against marketing propaganda

The Thyroid, A Fundamental and Clinical Text, Braverman and Utiger, 9th Edition, 2005

Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? Dr. Datis Kharrzian, Elephant Printing 2010