Disclaimer: I am not a physician and do not diagnose disease. The statements made here are for educational purposes only. Please see your health care professional before making changes in your diet or medications. Any of the information you may choose to use is your responsibility. Thyroid disease can be life-threatening and is not to be taken lightly. Treatment of some kind is critical and necessary.
July 2014- Two updates for those with thyroid issues.
Reseach suggests autoimmune thyroiditis, both Hashimoto's and Grave's, may be associated with an IMBALANCE of iodine and selenium. Both trace elements, along with zinc and iron, are needed for healthy thyroid function and the balance (as in all things) is the key. Just adding either (without balance) may make thyroid issues worse. Currently the ratio is not known but likely it is not less than 500 mcg nor more than 1,000 mcg of iodine and not less than 200 mcg nor more than 400 mcg methylselenocysteine. Curr Opin Endocrinol Diabetes Obes. 2013 Oct;20(5):441-8. doi: 10.1097/01.med.0000433066.24541.88. Review.
Olive Leaf Extract has been clinically shown to increase the conversion of T4 into T3 likely by increasing the enzyme that does the conversion. This may be a very simple way to enhance thyroid function. Effective dose is likely 500-1,000 mg daily. Phytother Res. 2002 May;16(3):286-7.
If you decide to consider supplements I suggest the Life Extension Sea Iodine 1,000 mcg one once a day; Jarrow Selenium Synergy one once a day and Planetary Formula Olive Leaf Extract one 2X a day. iherb.com has all three. Use this link to get a discount on your first order. Do NOT use iodine if you have an iodine allergy.
There is an accurate TSH home test available from homehealthtesting.com for about $30 (and they also do Vitamin D, a nice add on to order) While TSH may not be helpful to titrate ongoing treatment it is an excellent screening tool to monitor your need for treatment. TSH should be below 2.0, typically 1.3 or so in healthy persons. If yours is higher, consult your physician. If you need to monitor your treatment (how much thyroid do you need?) thyroid panels are available from Private MD (link is to a standard panel but for monitoring treatment consider the "TSH, free T3 and free T4" combo which you will find by clicking on the test categories / thyroid) Private MD Labs offers a 15% discount (discount link on their home page) so a TSH, free T3 and free T4 panel ($78) will be only $67. The http://drlowe.com site also has a link for reasonably priced thyroid testing. Life Extension offers a panel of free T3, free T4 and TSH here for about $100, less if you are a member. Life Extension also offers the reverse T3.
In February of 2009 a reformulation of Armour thyroid in the US seemed to have dramatically reduced its effectiveness. The manufacturer increased the amount of cellulose which in fact can bind nutrients/elements. It is possible to find natural thyroid, Westhroid and Naturethroid, in the US but they seem to be in short supply and are more expensive. This is devastating to many people who have worked so hard to 'get well'. It is possible to find dessicated thyroid outside the US. Some find chewing the tablets helps.
Low levels of dietary protein, omega-3, vitamin D, vitamin A, vitamin C, potassium, zinc, copper, lithium, iron, selenium, and magnesium affect your thyroid gland function. It is possible to test positive for hypo, hyper or auto-immune thyroid disease and yet correct the abnormal tests with excellent nutrition. Unless your thyroid disease symptoms are severe or life threatening you may want to try improving your nutrition before you commit to life long use of thyroid hormone. If you already take thyroid medication a good nutritional program will help you be as healthy as possible and allow your medication to work better. Do not stop medication without notifying your physician. Autoimmune thyroid disease almost always requires medication ongoing.
You have been diagnosed as having some form of thyroid disease. You may be hypothyroid, hyperthyroid, have Graves Disease or Hashimoto's Thyroiditis. This information has not been prepared to take the place of being monitored by your physician. It is to help you help your physician determine your correct dose of thyroid medication and help you both maintain the correct dose.
A CAUTIONARY NOTE: It is important to make sure your symptoms and blood work are not a result of adrenal insufficiency. Depressed thyroid and depressed adrenal symptoms are very similar.
Paul Robinson's book explains how to use thyroid hormones to 'fix' your adrenal response and almost always this will work with no other medication. The ONE exception may be if you are insufficiently supplied with vitamin C. Please read my July 2011 newsletter and make sure you get enough vitamin C EVERY day, twice a day, always. Liposomal C has the ability to restore tissue levels of C (brain, pituitary, thyroid, adrenals and more) more rapidly and efficiently than regular vitamin C and without gastric distress.
'Using Liposomal Vitamin C to Restore Adrenal Health'- The basic strategy is 2,000-3,000 mg of liposomal C three times a day for 2-3 months and 1,000 mg liposomal vitamin C twice a day ongoing (very important, including the twice a day recommendation). The best buy liposomal C may be found at Let's Have Health. Simple strategy, great scientific rationale and great results in current clients trying the protocol.
Cortisol, a primary adrenal hormone that is elevated under stress and depressed when the adrenal gland is exhausted, alters TSH and thereby T4 and T3. Alterations in adrenal function alter thyroid function but treating the thyroid will not make the underlying adrenal condition, if it exists, better. Consider a salivary cortisol test if you are currently being treated for thyroid and the results are not what you expected. If you have thyroid disease and are treated with a good combination of T3 and/or T4 your symptoms should resolve rapidly, especially if you use the circadian method explained in Recovering with T3, Paul Robinson's book. You may not have to use JUST T3 to get results but just T4 often won't work. Your symptoms will remain, alter, or become worse if adrenal dysfunction is present.
Cautionary note- there is a 'thyroid resistance syndrome' or 'reverse T3 syndrome' similar in character to 'insulin resistance'. This manifests as symptoms of low thyroid function but normal thyroid blood work. There also may be an insufficiency of certain enzymes needed to convert T4 to T3. There is significant evidence insulin resistance and thyroid resistance may be related. IF your 'fasting insulin' is greater than 8 uU/ml change your diet to reduce fasting insulin to under 6. Your thyroid function will improve. The fastest way to reduce fasting insulin is to follow the Time Restricted Feeding 8/16 plan. Lowering fasting insulin has resulted in a reduction in thyroid medication while experiencing an improvement in symptoms. Intermittent Fasting, Paleo or Protein Power diets will also reduce fasting insulin however some on the Paleo Diet have found thyroid problem increasing. TEST.
Also remember the top paragraphs. If your thyroid is 'normal' but you have symptoms of thyroid resistance try the iodine/selenium/olive extract combo for a month and see if you get relief. If you do, keep doing it. It does not fix the problem it feeds the system which removes the problem.
An imbalance of omega-3/omega-6 fatty acids may contribute to this condition as well as low tissue levels of vitamin C (see Liposomal C suggestions). Lowering omega-6 fats and dramatically increasing omega-3 (fish oil NOT flax, see Update on Essential Fats) has improved or normalized thyroid function in some persons.
A small dose (not less than 100 mcg nor greater than 400 mcg) of selenium (methylselenocysteine) balanced with iodine may improve this condition.
Selenium is critically important to thyroid function and selenium is being used to treat both Graves Disease and Hashimoto's Thyroiditis. Excess or insufficient iodine are frequently implicated in autoimmune thyroid disease, especially Hashimoto's Thyroiditis. Selenium use when iodine is deficient can make thyroid (and other health issues) worse. Think balance.
Iodine is critically important for healthy thyroid function and heart function. Iodine deficiency or excess increases the possibility of autoimmune thyroid disease. Selenium effectively treats iodine excess. Selenium and iron both play an important role in normal thyroid function. Mercury toxicity also alters thyroid function and increases the need for selenium. You need the 'right' amount of a nutrient, not too much, not too little. Doses of iodine greater than 1 mg. (1,000 mcg) are likely not needed.
You need a balanced diet with balanced minerals and trace elements to support your thyroid. No one mineral or trace mineral or 'pill' will do. Low protein and/or inappropriate fatty acids also decrease your body's ability to produce hormones or increase cellular resistance to hormones. Making sure your diet contains adequate protein and potassium (see other pages) and that your supplements contain enough but not too much of essential elements may restore thyroid function, will support thyroid disease treatment and likely protect the healthy thyroid from disease.
The maintenance dose, arrived at slowly, is 100-300 mcg. of Synthroid or Levothroid (T4) or 60-180 mg of Armour or Westhroid (whole thyroid) or if using just T3 50-90 mcg split over the day. There is a great difference in these doses and blood work combined with your response (how you feel) is the best indicator that you have reached your ideal dose. 1 grain means about 100 mcg of Synthroid or 60 mg of Armour or 25 mcg T3. 1.5 grain (150 mcg Synthroid or 90 mg Armour) is a typical maintenance dose. Dose is usually increased in increments of 25-50 mcg (15-30 mg whole thyroid) until your TSH falls within normal range, currently thought to be 2.0 or less..
On the correct dose of thyroid you will have stable blood sugar levels; normal appetite; energy; normal sleep patterns; no frequent urination; a basal temperature of 97.8-98.2; no hair loss; good hair texture-not coarse or fine; good circulation-warm hands and feet and the ability to warm up quickly when you get cold; good skin texture-not dry and thick or thin and oily; good skin color-normal, slightly pink without abnormal flushing-the palms of the hands and soles of the feet should not appear yellow or orange; normal size tongue-pink with no indentations around the edges; no athletes foot; good resistance to infection; normal mucous membranes-not excessive or thickened mucous; improvement or elimination of environmental and food allergies; normal perspiration patterns-not sweating without cause but having the ability to perspire when exercising or when the temperature rises; no night sweats; stable mood-not depressive, having curiosity and a desire to do and to have; enjoying exercise and feeling a benefit after working out; good short and long term memory; the ability and desire to experience sexual satisfaction; a good sense of taste and smell; good reflexes-neither too fast nor to slow; no constipation or diarrhea; a normal menstrual cycle of 3-5 days without heavy bleeding and without PMS.
Your dose of thyroid is too high (or you may have raised your dose too quickly) if: you experience undo sweating; heart palpitations; hunger-eating all the time without weight gain; a resting pulse above 90; quick movements; thin/fragile skin; a change in hair texture to very fine; a basal temperature above 98.2; eye or vision changes; headaches with no apparent reason; nervousness; tremor; unusual increase in amount and number of bowel movements per day; diarrhea. Ask your druggist for the written material available concerning your medication. Read all overdose symptoms and contraindications. The normal thyroid/healthy body converts more thyroxine,T4, into T3 (the active thyroid hormone) during stress, in colder weather and when you are ill or injured. You may be able to adjust your dose, with your doctor's consent, to fit the situation. To be able to do this successfully you need a prescription for an incremental dose in addition to your regular prescription.
Thyroid hormone consists of several fractions. The most important fractions are T3 and T4. Armour (or Thyroid-S) contains T1, T2, T3, T4 and more, Synthroid contains only T4 and Cytomel contains only T3. Some individuals appear to have a problem converting the inactive T4 found in Synthroid (or even Armour T4) into the active T3 . Zinc, selenium, and magnesium are required for this conversion, as well as other nutrients. Your physician can check to see if you have a problem by monitoring your free T3 levels. Also see the Private MD Labs testing at the top.
For details regarding the latest in thyroid recovery do visit http://recoveringwitht3.com/ and http://nahypothyroidism.org/ Also, test your fasting insulin. Keeping fasting insulin under 6 uU/mlwill keep your thyroid functioning at its peak.
Please remember your needs change with age, weather, illness and injury. What worked in the past may need adjustment today. Watch your symptoms. They are your body's way of talking to you.
A simple trick to improve thyroid function when you are on thyroid hormones (l-thyroxine, Synthroid, Armour, Nature-Throid, etc.) take your thyroid before bed.
...Every thyroid patient has heard the advice that for best results, we should take our medication first thing in the morning, on an empty stomach, and wait at least 30 minutes to an hour before eating. (And also, that we should wait at least three to four hours before taking calcium or iron, which can interfere with thyroid hormone absorption.)
...In 2007, Clinical Endocrinology reported on a small pilot study, which looked at the impact on thyroid hormone profiles by changing the time levothyroxine was taken from early morning to bedtime. They also evaluated the impact of this change on the circadian rhythm of TSH and thyroid hormones and thyroid hormone metabolism. The study, while small (12 subjects), was fairly conclusive in its findings, which the researchers said were "striking" and which have "important consequences for the millions of patients who take l-thyroxine daily."
The researchers found that the patients taking nighttime levothyroxine had a drop in TSH of 1.25 -- which is a significant change. They free thyroxine (Free T4) level went up by 0.07 ng/dL, and total triiodothyronine (Total T3) went up by 6.5 ng/dL. According to the researchers, there were no significant changes in the other factors.
Clin Endocrinol (Oxf). 2007 Jan;66(1):43-8. Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients.Bolk N, Visser TJ, Kalsbeek A, van Domburg RT, Berghout A.Source Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
Abstract OBJECTIVE: Standard drug information resources recommend that l-thyroxine be taken half an hour before breakfast on an empty stomach, to prevent interference of its intestinal uptake by food or medication. We observed cases in which TSH levels improved markedly after changing the administration time of l-thyroxine to the late evening. We therefore conducted a pilot-study to investigate whether l-thyroxine administration at bedtimeimproves TSH and thyroid hormones, and whether the circadian rhythm of TSH remains intact. DESIGN Patients were studied on two occasions: on a stable regimen of morning thyroxine administration and two months after switching to night-time thyroxine using the same dose. On each occasion patients were admitted for 24 h and serial blood samples were obtained.
PATIENTS: We investigated 12 women treated with l-thyroxine because of primary hypothyroidism, who used no medication known to interfere with l-thyroxine uptake.
MEASUREMENTS:Patients were admitted to hospital and blood samples were obtained at hourly intervals for 24 h via an indwelling catheter. Following this first hospital admission, all women were asked to switch the administration time from morning to bedtime or vice versa. After 2 months they were readmitted for a 24-h period of hourly blood sampling. Blood samples were analysed for serum TSH (immunometric assay), FT4 and T3 (competitive immunoassay), T4 and rT3 (radioimmunoassay), serum TBG (immunometric assay) and total protein and albumin (colourimetric methods).
RESULTS: A significant difference in TSH and thyroid hormones was found after switching to bedtime administration of l-thyroxine. Twenty-four-hour average serum values amounted to (mean +/- SD, morning vs bedtime ingestion): TSH, 5.1 +/- 0.9 vs 1.2 +/- 0.3 mU/l (P < 0.01); FT4, 16.7 +/- 1.0 vs 19.3 +/- 0.7 pmol/l (P < 0.01); T3, 1.5 +/- 0.05 vs 1.6 +/- 0.1 nmol/l (P < 0.01). There was no significant change in T4, rT3, albumin and TBG serum levels, nor in the T3/rT3 ratio. The relative amplitude and time of the nocturnal TSH surge remained intact.
CONCLUSIONS: l-thyroxine taken at bedtime by patients with primary hypothyroidism is associated with higher thyroid hormone concentrations and lower TSH concentrations compared to the same l-thyroxine dose taken in the morning. At the same time, the circadian TSH rhythm stays intact. Our findings are best explained by a better gastrointestinal uptake of l-thyroxine during the night.
Arch Intern Med. 2010 Dec 13;170(22):1996-2003. Effects of evening vs morning levothyroxine intake: a randomized double-blind crossover trial.Bolk N, Visser TJ, Nijman J, Jongste IJ, Tijssen JG, Berghout A.Source Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands. email@example.com
Abstract BACKGROUND:Levothyroxine sodium is widely prescribed to treat primary hypothyroidism. There is consensus that levothyroxine should be taken in the morning on an empty stomach. A pilot study showed that levothyroxine intake at bedtime significantly decreased thyrotropin levels and increased free thyroxine and total triiodothyronine levels. To date, no large randomized trial investigating the best time of levothyroxine intake, including quality-of-life evaluation, has been performed.
METHODS:To ascertain if levothyroxine intake at bedtime instead of in the morning improves thyroid hormone levels, a randomized double-blind crossover trial was performed between April 1, 2007, and November 30, 2008, among 105 consecutive patients with primary hypothyroidism at Maasstad Hospital Rotterdam in the Netherlands. Patients were instructed during 6 months to take 1 capsule in the morning and 1 capsule atbedtime (one containing levothyroxine and the other a placebo), with a switch after 3 months. Primary outcome measures were thyroid hormone levels; secondary outcome measures were creatinine and lipid levels, body mass index, heart rate, and quality of life.
RESULTS:Ninety patients completed the trial and were available for analysis. Compared with morning intake, direct treatment effects whenlevothyroxine was taken at bedtime were a decrease in thyrotropin level of 1.25 mIU/L (95% confidence interval [CI], 0.60-1.89 mIU/L; P < .001), an increase in free thyroxine level of 0.07 ng/dL (0.02-0.13 ng/dL; P = .01), and an increase in total triiodothyronine level of 6.5 ng/dL (0.9-12.1 ng/dL; P = .02) (to convert thyrotropin level to micrograms per liter, multiply by 1.0; free thyroxine level to picomoles per liter, multiply by 12.871; and total triiodothyronine level to nanomoles per liter, multiply by 0.0154). Secondary outcomes, including quality-of-life questionnaires (36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale, 20-Item Multidimensional Fatigue Inventory, and a symptoms questionnaire), showed no significant changes between morning vs bedtime intake of levothyroxine.
CONCLUSIONS:Levothyroxine taken at bedtime significantly improved thyroid hormone levels. Quality-of-life variables and plasma lipid levels showed no significant changes with bedtime vs morning intake. Clinicians should consider prescribing levothyroxine intake at bedtime.
TESTING: To really know your thyroid status you need 5 tests, all available from http://lef.org
If you order supplements from iherb.com (links follow) and are new to them use this link for a $10 discount on your first order. Supplement combos I have found easy and helpful include: Now Foods Liquid Multi-Gels, Solaray Provide, Natrol My Favorite Multiple Original tablets or Seeking Health Optimal Multivitamin if you're MTHFR, available from iherb.com, vitacost.com or vitaglo.com There are other multiples available with similar composition. As long as your supplement contains most of the suggested nutrients and you are comfortable with it and are able to take the full dose daily, it is fine.
MTHFR GENE POSITIVE- IF YOU HAVE ONE OR MORE OF THE MTHFR GENES DO NOT USE ANY SUPPLEMENT CONTAINING 'REGULAR' FOLIC ACID. AVOID ALL PROCESSED AND FORTIFIED FOODS. THE ONLY FOLATE YOU SHOULD CONSIDER IS L-METHYLFOLATE. REGULAR FOLIC ACID MAY MAKE YOU WORSE. Use supplements that are either folate free or contain l-methylfolate. If you need help determining your genetic status and the influence of nutrition email for the information packet. Analysis of 23andme testing is available. 23andme no longer provides analysis due to a ruling by the FDA but does provide the raw data needed fro analysis. Order your gene test here and email for an appointment.
Another excellent source for supplements, competitive prices and excellent customer service is Swanson Vitamins. This link will take you to their special deals page. Worth a look.
In general, supplements do not contain taurine, or some of the trace minerals and you may need to purchase them separately. In particular sufficient selenium or iodine may be an issue. A good source of selenium is Jarrow Selenium Synergy. For iodine the Life Extension Sea Iodine. Both may be ordered from iherb.com with a discount on your first order.
When T4 or T3 are low the body is less able to convert vitamin D into the active hormone and also cannot convert beta-carotene into retinol, the active form of vitamin A. Frequently there is low production of hydrochloric acid which leads to malabsorption of B-12 and iron. Following diagnosis and treatment with thyroid hormones you can help restore body levels of nutrients by increasing the amounts of these nutrients in food or with supplements for about 2-3 months.
If the thyroid is overactive or if you have been taking too high a dose of thyroid hormone there may be a significant loss of muscle mass and bone mass. All nutrients, protein and minerals and trace minerals should be at the highest levels for 3-6 months after beginning treatment.
If after trying everything you still find yourself suffering from fatigue and depression visit http://www.stopthethyroidmadness.com
Spend some time and read the stories. You will be inspired and may find a way to get back your 'self'. Blessings, Krispin
Mary Shomon's thyroid column on http://thyroid.about.com/ is a great place to
find information as is
Stop The Thyroid Madness.
Thyroid disease is a life long problem. Once it has been determined that you have or a family member has a thyroid disorder, monitored treatment is imperative. During your lifetime your thyroid may become hypo (low), hyper (high) or even normal. You need to be informed so that you have the ability to take care of your own body. Your physician is your partner in staying healthy. Use him or her to your best advantage. The only safe use of medicine, including all hormones, is informed use.
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