Friday, August 3, 2012

Hypothyroidism: Tests, Diet and Supplements

I have seen a couple of cases of hypothyroidism very recently.

Hypothyroidism is basically an inavailability of T3 hormone to the cells. The cells need the hormone for energy production. T3 hormone is the means by which the brain controls energy utilization in the body. The Hypothalamus indicates to the Pituitary gland that more energy is required. The Pituitary generates TSH to signal the thyroid to create T4/T3.

There are 4 tests that can distinguish different cases of hypothyroidism.
1) Free T3
2) Free T4
3) TSH
4) Reverse T3

For best feeling Free T3 must be in the upper half of the normal range. Free T4 must also be in the upper range. TSH should be around 1, preferably below, but not lower than 0.3. If T4 is high and T3 is low, its quite likely that T4 is being converted to RT3. The RT3 range can distinguish the case.

If T3 and T4 are low and TSH is also low, then there is a problem with the Pituitary gland.
If T3/T4 are high and TSH is also high, then also there is a problem with the Pituitary, and possibly there is a tumor there.
The normal hypothyroidism case is that T3 and T4 is low and TSH is high.
If T3/T4 are high and TSH is very low, then it is a hyper thyroid case. But if the symptoms are hypothyroid then it is probably a thyroiditis case, where the autoimmune attack is ongoing. It could also be a Zinc Deficiency case, but that would be rare.

So how do we get hypothyroidism?

There are two reasons.
1) Thyroiditis - An Autoimmune disorder where, the body's immune system is killing the Thyroid cells. This is the most common cause.
2) Iodine Deficiency - This can happen due to Iodine, Selenium deficiency. This is also fairly common.
3) Zinc Deficiency - Zinc is required for absorbing T3 in the cells. This is quite rare.
4) Other reasons - These are rare, and occur due to medicines or surgical procedures.

Thyroiditis normally happens due to overactive immune system which is not able to identify the right proteins to attack. The ability to identify properly rests a lot on VitD levels. This vitamin unfortunately is pretty low in most people in the present times. The immune system becomes over active because some offensive proteins are entering the blood stream. This is most likely due to a leaky gut, but in rare cases the immune system can get primed from the gut itself.

There are several types of Thyroiditis
1) Hashimoto's - This probably occurs due to leaky gut causing the immune system to become overactive.
2) PostPartum - This occurs after pregnancy, because the immune system undergoes a change at the time. This could also be related to the leaky gut.
3) Others related to medical procedures or radiation.

Thyroiditis can be tested with the following
1) Anti-ThyroGlobulin 
2) Anti-TPO

Diet and Supplements

Diet and supplement depend on the cause of the hypothyroidism.

First we need to supplement to get the T4/T3 hormone to the right level.

The easiest is to supplement with a form of Thyroxine (T4). T4 converts to T3, and both the required hormones are available. This works for most people. But for some additional T3 hormone supplementation is required. People whose thyroid gland is inactive to a very large extent, should consider Dessicated Thyroid gland supplements, because these provide other hormones as well. Particularly calcitonin hormone is required to prevent a possibility of osteoporosis.

Generally people take the Supplemental hormone without monitoring. The monitoring via FT3/FT4/TSH is very expensive. A much cheaper solution is to find the body temperature and monitor it to find whether the supplementation is sufficient.

For measuring the body temp use an analog thermometer. Keep the thermometer in the mouth for around 5 minutes for proper temperature. Also try to avoid doing anything during the test.

Take the temperature at 3hr 6hr and 9hr after waking up. Average the 3 numbers. The aim is to get the temperature to 98.4F, with supplementation.

If there is a lot of variation (>0.6F) in day to day average temperature, then the adrenal might be implicated. This may cause problems while supplementing with T4, and Cortisol (Hydrocort)  supplementation may also be required.

If the supplementation of T4 is not helping raise the Body Temperature, then FT3/FT4/TSH/RT3 tests should be made to determine, what is going wrong. It maybe that T3 supplementation is also required. If a lot of T4/T3 hormone is required then it might be that a large part of the thyroid gland is not working, then it would be better to check the thyroid gland with radiology. If indeed a large part is inactive then it is much better to use dessicated thyroid gland.

If the cause is Thyroiditis, then it is important to eat a very strict paleo diet (ie no grains/legumes/milk) without nightshades. Specifically avoiding things that are major sources of allergies, like wheat, soy, peanuts, milk solids.

For Thyroiditis it is also important to normalize Vitamin D. A low vitamin D is normally associated with Auto-immune diseases.

In any case an effort should be made to normalize Selenium and Iodine intake. Goat/Lamb Kidneys and Brazil nuts are the major sources of selenium. Kelp powder/Lugol's solution/Iodoral are some of the sources of Iodine. Effort should be made to raise the intake of iodine to 1.5-3mg/day, except in case of Thyroiditis.

It is important to remember that T3 levels vary a lot during the day. Even T4 can vary a lot. In case of Thyroiditis the levels vary a lot if the attack is on going. This is why, the body temperature test can be more reliable indicator of Thyroid function if it really Thyroid problem. The 4 hormone tests are important to distinguish where the problem exists.


  1. Thank you for this information and your insights. My 11 year old son was diagnosed with Hashimoto's one year ago. He has been taking medication and while it normalizes his TSH numbers, he still had all the symptoms (weight gain,fatigue,acanthosis, and constipation) Recently, he has stopped eating wheat, milk, sugar and eggs and the results have been astounding. His skin problems have cleared up, his energy level is normal, he is no longer constipated and finally he is experiencing slow and steady weight loss. I agree that the Paleo diet is the way to go with Hashimotos.

  2. I am interested in a similar article on hyperthyroidism. My TSH was twice of the normal range, and I have been asked to be on thyroid control pills. There must be other ways. Im in the 30s.

    1. You are saying your TSH is twice of the normal range. This is not HyperThyroidism. It is HypoThyroidism. When your T4 drops, the Pituitary gland increases Thyroid Simulating Hormone (aka TSH) to force the Thyroid gland to produce more T4. So TSH high means hyper.

      T4 is converted to T3, but T3 is the main hormone. T3 status actually determines how well you feel. T3 status will depend on your T4 status, although they may be not be at the same end of the range.

    2. Unfortunately, if your T4 is low, then there is no other option but take supplemental T4. Iodine may help, but only if you have a deficiency, and it causes problems in the case of Thyroiditis.

      What you can do is to find out why this is happening. If it is Thyroiditis, then it would be best to eat a very low toxin diet to hopefully prevent further damage. Also it is probable that the autoimmune cause can create problems for other organs too. Avoiding the current standard toxic food is anyway a good option.

    3. Ok, sorry I get confused. Yes, my TSH currently is 9.9. How does one find out why this is happening? I've not had any major diet changes or significant lifestyle changes, nor have I had TSH to be high in past blood tests.

    4. You should get Anti-TPO tested. This will tell you whether it is due to autoimmune damage.

      Anti-ThyroGlobulin will tell you whether the damage is ongoing.

      According to Chris Kresser, in 90% of the cases, the hypothyroid condition is due to Autoimmune damage. Very rarely it is due to low iodine or other issues. So clear that one out first.

    5. I hope you are taking T4 hormone supplement. What are your Free T3 and Free T4 values?

  3. Yes, synthroid. I don't see Free T3 and T4 listed in my report. The elements I had out of tune this time were RBC (5.82) instead of the range of 4.14 - 5.80, MCV (77) instead of 79-97, MCH (25.6L instead of 26.6-33), TSH as reported, and Vitamin D (25-Hydroxy instead of 30-100). My doctor felt I only needed to correct TSH and Vitamin-D - others were nominally off.

  4. This is what the wikipedia says about a high reading of MCV. I think all the three are related. You could get B12 tested.

    In presence of hemolytic anaemia, presence of reticulocytes can increase MCV. In pernicious anemia (macrocytic), MCV can range up to 150 femtolitres. An elevated MCV is also associated with alcoholism[3] (as are an elevated GGT and a ratio of AST:ALT of 2:1). Vitamin B12 and/or folic acid deficiency has also been associated with macrocytic anemia (high MCV numbers).