For much of my adult life, I’ve experienced mild fatigue. It never made me want to crawl under the covers and sleep all day, nor did it inhibit me from pursuing my interests. I’ve never suffered from depression, and until just a few years ago my metabolism burned hot.
During the worst of times, I just felt like I had one foot on the gas and one on the brakes. And with a spirited and seemingly energetic mother who experienced similar issues, I figured this was simply my lot in life.
In 2002, at the age of 32, I was told in a routine checkup that my thyroid was “borderline.” I knew that the thyroid was a butterfly-shaped gland in the neck that controls metabolism and energy, but with no further discussion or instruction from my doctor about what borderline meant, I didn’t give it much consideration. I later suffered from symptoms that were, unknown to me at the time, related to the diagnosis. I was chilled in 75-degree weather, had dry skin and itchy eyes, and at times would experience significant hair loss. I was also becoming increasingly restless and impatient.
It wasn’t until 2008 that I discovered I suffered from the most common cause of hypothyroidism, Hashimoto’s thyroiditis, an autoimmune condition that causes the body to attack its own thyroid tissue.
Even though I was trained as a holistic nutrition coach, I knew little about Hashimoto’s. Confronted with the mysterious four-syllable verdict, I countered, “Um, no, I don’t have that, thank you.”
My labs told a different story. When my then-doctor asserted that I had to be on thyroid drugs for the rest of my life — drugs that can cause heart palpitations, shortness of breath, troubled sleep and a host of other side effects — I again blurted, “I don’t think so,” and my journey into sleuthing low thyroid function and autoimmunity began.
It’s estimated that hypothyroidism, or underactive thyroid, affects more than 30 million women and 15 million men. (Hyperthyroidism, or overactive thyroid, is much less common.) “Thyroid dysfunction affects our health systemically,” says family nutritionist and naturopathic endocrinologist Laura Thompson, PhD. “Since the endocrine system [which is made up of glands that produce our bodies’ hormones] is responsible for growth, repair, metabolism, energy and reproduction, any slowing of the thyroid can have significant implications for our overall health.”
Datis Kharrazian, DHSc, DC, MS, a leading expert on autoimmunity, further points out in his book, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? (Morgan James Publishing, 2010), that autoimmune disease accounts for a whopping 90 percent of Americans with hypothyroidism, mostly due to Hashimoto’s. The other 10 percent are afflicted with non-autoimmune hypothyroidism.
Unfortunately, patients with hypothyroidism suffer from symptoms that are rarely traced to a sluggish thyroid. If you’re feeling blue or unmotivated, you may be prescribed an antidepressant. If you’re constipated, you’re told to take a laxative. If you’re having difficulty sleeping, you’re given a sleeping aid. If you’re overweight and having trouble shedding pounds, you’re instructed to work harder at the gym or consume fewer calories (which can actually exact a greater toll on the thyroid gland). And even when conventional docs do diagnose hypothyroidism, the drug regimens they routinely prescribe don’t always do the trick.
The good news is that knowledge of proper diagnosis methods, dietary choices, lifestyle modifications and thyroid drug alternatives can help many people reclaim their health. That’s what happened to me.
I simply focused on whole-foods nutrition and some simple thyroid-friendly lifestyle modifications. I am thankfully now in remission from Hashimoto’s and, motivated by the mantra “We teach what we most need to learn,” I’ve changed the focus of my health-coaching business in hopes that those who have thyroid issues can benefit from my research.
Misdiagnosed, Misunderstood
The thyroid is hailed as “the master gland” of our complex and interdependent endocrine system. Put another way, it’s the spoon that stirs our hormonal soup. It produces several hormones that transport energy into every cell in the body and are vital for feeling happy, warm and lithe. The gland also acts as the boss of our metabolism. Which is why symptoms of hypothyroidism include weight gain and fatigue — as well as constipation, depression, low body temperature, sleep disturbances, difficulty concentrating, edema (fluid retention), hair loss, infertility, joint aches and light sensitivity.
In part because these symptoms are so common, the thyroid is too often the last place medical practitioners look for a problem. When doctors do choose to run labs, they routinely operate under the misguided conviction that hypothyroidism can be diagnosed via a single blood test of thyroid stimulating hormone (TSH), which ultimately reveals little about overall thyroid function. And even when a TSH test is relevant, the interpretation of the results is often incorrect.
Because TSH rises as thyroid function wanes, high TSH indicates that the thyroid is underperforming. But many doctors mistakenly believe that TSH over 5.0 is worth treating, when, according to most functional medicine doctors, anyone with TSH over 3.0 has hypothyroidism. (Harvard-educated integrative physician and gynecologist Sara Gottfried, MD, argues that women tend to feel best with TSH between 0.3 and 1.0.)
It’s no wonder thyroid patient and activist Janie Bowthorpe, MEd, author of Stop the Thyroid Madness (Laughing Grape Publishing, 2008), has nicknamed TSH “thyroid stimulating hooey.”
It’s estimated that millions more sufferers could be diagnosed if proper testing was commonplace. Unfortunately, the antibodies that show the presence of Hashimoto’s — thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) — happen to be on the list of thyroid labs that most conventional docs don’t perform.
Because thyroid hormones directly act on so many parts of the body, though, it’s essential to follow up with proper lab tests if you self-identify a problem. (For more on lab testing, as well as a simple at-home test, see “Testing in the Lab” and “Testing at Home,” below.) When you’re tested, it’s also a good idea to be checked for adrenal fatigue, since those with hypothyroidism often have some level of the condition and it can be difficult to treat the thyroid without assessing both systems. (For more on adrenal fatigue, read “Pick Yourself Up.”)
Going to Battle
Hashimoto’s is one of the most common forms of autoimmune disease in the United States.
Other examples of autoimmune conditions include rheumatoid arthritis, type 1 diabetes, multiple sclerosis, lupus, celiac disease, Crohn’s disease and psoriasis. In the presence of autoimmunity, normal tissue is confused with a pathogen, and your body’s immune system mistakenly launches a seek-and-destroy mission against itself. When a person has Hashimoto’s, antibodies specifically attack and damage his or her thyroid tissue.
With the number of people suffering from an autoimmune disease increasing markedly in recent decades (50 million Americans are now affected), researchers are scrambling to find cures.
There are several theories about how autoimmunity is triggered, including childhood trauma, genetic predisposition and exposure to environmental toxins. But most conventional healthcare practitioners are unaware of how to manage it because there is no pharmaceutical for autoimmune diseases. There are only drugs to help ease the diseases’ symptoms. As a result, the underlying issues continue to smolder.
And although supplemental iodine is generally the correct regimen for those 10 percent of patients who have non-autoimmune hypothyroidism, it is not the treatment of choice for those with Hashimoto’s. Too much iodine can overstimulate the thyroid and cause anxiety and sleeplessness. Which is why, according to Kharrazian, if you have Hashimoto’s, taking supplemental iodine is “like throwing gasoline onto a fire.”
Instead, the first line of defense against Hashimoto’s is dietary change. There is a slew of nutritional recommendations you can follow — all of which helped me in my journey toward Hashimoto’s remission — but you should get started by completely removing gluten from your life, which has been shown to trigger a response from the immune systems of even those without digestive gluten sensitivity.
While many health experts suggest that none of us should be eating gluten, Hashimoto’s sufferers have a distinct reason to swear it off, according to Kharrazian. Because gluten protein closely resembles thyroid tissue, he says, eating it puts the immune system in attack mode, exacerbating the problem. There is no such thing as moderation when it comes to gluten and Hashimoto’s, he says, since even the smallest amount can trigger an autoimmune attack for several months.
Thyroid experts also advise eating foods with thyroid-friendly vitamins and minerals, such as vitamin D, iron, selenium and zinc, and avoiding foods that inhibit thyroid health, such as raw cruciferous vegetables, soy, sugar and caffeine. (For a detailed list of nutritional dos and don’ts, see the Web Extra below.)
After changing dietary habits, some people have to turn to thyroid drugs to treat Hashimoto’s. In some cases, medication is required indefinitely, especially when Hashimoto’s has gone undiagnosed for a long time and the thyroid is damaged to the point that it can no longer produce hormones. In my situation, I halted the immune attack with good nutrition and self-care, and there was not so much damage to my thyroid that a replacement hormone was warranted.
I was lucky, but even if you do need thyroid drugs, it’s important to know that they are not always a lifelong sentence. “Often, patients can reduce their medication and sometimes even go off it entirely,” says Thompson. “It depends on the degree and duration of imbalance.”
If you do need drugs, it’s important to work with a qualified doctor to find what type of medication, and what dosage, works well for you. As Gottfried puts it, “Finding the right thyroid drug is like trying on shoes,” and no matter what sort of treatment you may ultimately require, it’s all about experimentation, so don’t lose hope.
The specific hormones the thyroid produces that are most critical to our health are triiodothyronine (T3) and thyroxine (T4), both of which regulate metabolism. The most popular thyroid drug, Levothyroxine (most commonly known as Synthroid), is a synthetic T4-only drug.
In our bodies, T4 is a mostly inactive hormone and nicknamed “the storage closet” or “the lame duck.” It is the forerunner to T3, which is the predominant and active hormone and which has the greatest affect on our health and well-being. The body is designed to convert T4 to T3, but many people have trouble with this conversion, mostly due to stress, hormonal and gut imbalances, and nutritional deficiencies. In other words, if the body is to utilize a T4-only drug, the wheels that mobilize the T4 to T3 conversion need to be well oiled.
Some report a honeymoon period with Levothyroxine, where they feel better initially, only to revert to feeling unwell or have lingering symptoms. The continued health complaints often bring on increased dosages of thyroid meds and sometimes antidepressants or anti-anxiety prescriptions. Simply put, T4-only drugs fail many people.
What often works, however, is a combination T4-T3 medication. Biodentical T4-T3, known most commonly as Armour Thyroid, for example, comes from dried porcine thyroid. These natural hormones have been successfully used since the late 1800s and, after decades of the prevalence of T4-only prescriptions, are gaining use again. Switching from Levothyroxine to “tried and true” Armour Thyroid has proven extremely effective for many people.
Above all else, addressing hypothyroidism is an exercise in becoming a proactive patient. It’s imperative to approach a healthcare provider with informed confidence and to insist on proper testing. If your doctor uses outdated lab-reference ranges or doesn’t test for Hashimoto’s, don’t settle for a “you’re fine” diagnosis. Instead, try to find a functional medicine doctor who understands thyroid issues and knows that there’s rarely a silver-
bullet solution. (Go to http://j.mp/PJ4upP to locate one.)
It takes time and patience to heal, but I’m living proof that you can get there.
Jill Grunewald is a Minneapolis-based holistic nutrition coach, health and wellness writer, and proud Experience Life ambassador.
hi jill, l desperately need help . i went to the doctors for chronic joint pain and very tired all the time..l have high cholesterol and triglycerides, and was told i have hypothyroidism and vit d was only 12% very low..lve read you page…not sure what to really do except to eat healthy, cause i dont want to take the meds they offer ..lm current and not on any meds for these conditions..your input is greatly desired.
I recently, have lost about 40lbs… eating yes, Raw vegetables, mostly..
Thyroid, problems in run my, family…I have, notice new growth, in my thoat area…Doctor’s have tested…and telling me…I will probaly have to go on medication…I feel great, but do not want to take any hormanal medications…
I am, so glad, god let me See this article…about your thyroid!!
Thank u so, very much..
E. Tolliver
Thanks for the article. Is was informative. My main concern is losing my hair. Is there anything I can do or us to prevent this? Do you have any recipes to share?
Great article! Bad thyroids run in the family (both hypo and hyper). I sit on the hypo side, no medications (I believe meds do more harm than good). My question though, why exactly is caffeine bad?
Many thanks for this great article.
Thank you, Nesrin.
This is the best article I have read! I have not been diagnosed yet but I was told my adrenals are fatigued and my cortisol levels were not normal. I think I need more testing done. Also I didn’t realize kids could have this autoimmune disease. My child stuggles with concentration. So he has been diagnosed with ADHD. If I am struggling and my mother as well. Could it be possible we all have the same thyroid problem?
Lisa – Your post concerns me. If your adrenals are fatigued and your cortisol levels are off you need further testing. Without adrenal support your body is in danger. Also, if your cortisol levels are off there is a good chance that your pituitary is not working as it should. I have had all these things and have lived with replacement hormones and steroids for the past 17 years. Please, go for follow-up testing, these gland issues are nothing to mess around with or put off, they can lead to serious life-threatening complications.
Best of luck to you.
Bonita
Hi Lisa, yes, thyroid issues can run in families, and from what I understand, there is an even stronger genetic component with autoimmune conditions, of which there are many manifestations.
Hello, I am a “thyroidless” person. After a hyperthyroid crisis, modern medecine made me burn my thyroid away with readioactive iodine. I have struggled to find other people/experts who I can connect with and learn more about my specific challenges, causes of my condition, etc. If you have advice it would be much appreciated. Thanks, DUane
Hi Duane, I’ll say the same thing to you that I did to Steph below. The best thing that people who’ve had a total thyroidectomy can do is to find a drug or drug combination that works for them (the “shoe” analogy from the article) and to nourish and support the adrenals.
Armour thyroid is NOT bioidential. Pig thyroid contains a T4 to T3 ratio of 4 to 1, while human thyroid has a 14 to 1 ratio of these hormones. That’s a significant difference that can cause serious imbalances.
Hi Bean, many people don’t need the supplemental T4, bioidentical or not. So the T3 in Armour (or Cytomel or Thyrolar) proves very helpful for a lot of people. Thyroid drugs cause “serious imbalances” when they’re mis-dosed.
Great info. Thanks.
I was recently diagnosed with leaky gut and as I do my research, I see more and more ties between leaky gut and all auto immune diseases, especially thyroid issues. I just wanted to throw that out into the mix for anyone looking for a broader net to cast on their problem. I’m hopeful that by repairing my gut that will leave me one step closer to remedying my thyroid issues.
Best advice — find a good functional medicine doctor. Stay away from traditional medicine on this issue.
Hi Jodi, I couldn’t agree with your last sentence more. And yes, healing the gut is critical for any autoimmune condition, as much of our immune system is housed there.
Any tips for people who’ve had their thyroid removed and are on thyroid replacement medications? My friend has had an awful time, especially with doctors not getting the medications right (she was overmedicated for quite a while and is still suffering ill effects).
Any nutritional support/guidance that would only help, not interfere, with her complicated situation? She hasn’t found much info out there for people MISSING their thyroid.
Hi Steph, the best thing that people who’ve had a total thyroidectomy can do is to find a drug or drug combination that works for them (the “shoe” analogy from the article) and to nourish and support the adrenals.
As a nutrition communications professional and a thyroid cancer survivor, I read your article with great interest. While I think it is very informative and well-written on the whole, I’m concerned about your recommendation to avoid raw cruciferous veggies and soy and your suggestion that such foods are harmful to thyroid health. Existing scientific literature on the effects of thiocyanates and isoflavins from food on thyroid function in healthy, non-smoking humans, does not support such a recommendation. On the contrary, such foods have been found to be protective against certain cancers. Thanks for your attention. See:
Brent GA. Environmental Exposures and Autoimmune Thyroid Disease. Thyroid 2010 July; 20(7): 755â”761. doi: 10.1089/thy.2010.1636
Dal Maso L, Bosetti C, La Vecchia C et al. Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control. 2009 Feb;20(1):75-86.
de Souza dos Santos MC, Goncalves CFL, Vaisman M et al. Impact of flavonoids on thyroid function. Food and Chemical Toxicology, Volume 49, Issue 10, October 2011, Pages 2495-2502.
Doerge DR and Chang HC. Inactivation of thyroid peroxidase by soy isoflavones, in vitro and in vivo. Journal of Chromatography B, Volume 777, Issues 1â”2, 25 September 2002, Pages 269-279.
Hampl R, Ostatnikova D, Celec P et al. Short-term effect of soy consumption on thyroid hormone levels and correlation with phytoestrogen level in healthy subjects. Endocr Regul. 2008 Jun;42(2-3):53-61.
Messina M and Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid. 2006 Mar;16(3):249-58.
Milerov J, Cerovsk J, Zamrazil V et al. Actual levels of soy phytoestrogens in children correlate with thyroid laboratory parameters. Clin Chem Lab Med. 2006;44(2):171-4.
Teas J, Braverman LE, Kurzer MS, et al. Seaweed and soy: companion foods in Asian cuisine and their effects on thyroid function in American women. J Med Food. 2007 Mar;10(1):90-100.
Vanderpas J. Nutritional epidemiology and thyroid hormone metabolism. Annu Rev Nutr. 2006;26:293-322.
Hi Kathy, yes, cruciferous vegetables have incredible cancer-fighting properties, and I’ve written about their superpowers. I eat them regularly, but never raw. And soy is the probably the most controversial food on the planet. I don’t have the last word on it, but the majority of the doctors and experts I respect and follow feel that its estrogen-mimicking properties make it something that should be eaten in moderation, if at all. I tell my clients that fermented soy is fine, on occasion.
Hi Lauren, there are a few websites from where you can order your own labs. They’re listed below. You’ll having to find a local clinic that will do the blood draw. Good luck.
http://www.thyroid-info.com/diet/tshtest.htm < http://www.thyroid-info.com/diet/tshtest.htm>
For TSH, free T3, free T4, and the two thyroid antibody tests (TgAb, TPO)
http://www.healthcheckusa.com/Find-a-Test/46823/ < http://www.healthcheckusa.com/Find-a-Test/46823/>
There are lots of testing options on this site. You can click on ‘Real Thyroid Help,’ ‘Stop the Thyroid Madness,’ or ‘Thyroid Screenings.’
MyMedLab: https://sttm.mymedlab.com/sttm-profiles/sttm-bthyroidb-complete
Direct Labs: http://bit.ly/nOA1xT
Any Lab Test Now: http://anylabtestnow.com
Canary Club: http://www.canaryclub.org/ — Comes with detailed explanations.
Yours in health,
Jill
Thanks for the article. I had noticed that even if I’d had tea w/ sugar in the morning, then I would be easily fatigued during my evening workout. Your strong recommendation on quitting the sugar and caffeine habit is finally going to convince me to remove this item from my diet…!
Hi Rizwan, thanks for your comment. I’m glad this article was so persuasive for you!
Excellent article! However, sugar and caffeine are “PRO-thyroid” substances and not the terrible twosome as stated. Also excess iron is bad news when it comes to thyroid function.
I highly recommend that you read Ray Peat’s work to gain a more complete understanding of the endocrine system:
http://raypeat.com/articles/
Hi J.W., I do have a pretty good understanding of the endocrine system, thanks, and I fervently disagree that sugar and caffeine are good for the thyroid. This is counter to everything that the 15+ thyroid doctors and experts I’ve studied over the last few years are claiming. Sugar and caffeine are terrible for the adrenals as well, and any harm done to the adrenals is harmful to the thyroid.
Jill,
I was diagnosed with Hypothyroidism when I was 6 years old but my first Endocrinologist, my mother, and I all believe I developed the condition when I around 3 years old because my levels were so off and I started showing signs that there was something wrong when I was a toddler. I am now 24 and have been on medication since then. We have no clue what caused my Hypothyroidism because as far as I know I was never tested for Hashimoto’s and I’m the only person in my family who has had the condition since childhood. My maternal Grandmother did have it, but she developed it late in life like most people do; we are also the only ones in my entire family (and I have a big family) who have been diagnosed with the condition. I do plan on having my doctor test me for Hashimoto’s the next time I see her, but is there a way to self test for it at home. I have removed gluten from my diet before to see if doing so would help my ADHD but I did not notice anything. I’m also afraid that changing my diet will make me lose weight because unlike most with Hypothyroidism I am rather thin and have a BMI just with in the normal range.
I highly recommend the book Hypothyroidism Type 2 The Epidemic by Mark Starr M.D. and the website http://www.stopthethyroidmadness.com Very informational and awesome.
OH THANK YOU! I’ve been diagnosed with Hashimoto’s 2 years ago and it’s so incredibly nice to feel understood. There are definitely some issues I will discuss further with my health practitioner and my GP. I’ve looked up a lot of stuff on Hashimoto’s and I’ve never found such an informative article.
I am seriously gutted though about the recommendation of cutting out the caffeine. Ouch!
Thanks again!
Hi Kashi, I’m glad you found this helpful. If you need help kicking the coffee habit, try Teeccino or Dandy Blend.
Jill,
I had my thyroid removed because of cancer but was also diagnosed with Hashimoto’s before having my thyroid removed. Would I still benefit from a Gluten free diet?
Hi Jim, I really feel that abstaining from gluten is good for all of us. Even my clients who don’t have Hashimoto’s are benefiting greatly from going GF. It’s been stated that 80% of the population has gluten intolerance, and 90% of them are unaware of it. Try it and see if you feel differently. Good luck!
Jill-
one question – the main article highly recommends gluten free, but the elsewhere you talk about whole grains?
is quinoa the answer?
ms
Hi MS, quinoa is technically a seed, but many people refer to it as a grain. And yes, I eat it regularly. It’s high in protein, so it’s a great choice. The “answer” lies in eating gluten free whole grains like amaranth, teff, rice, corn, or millet. But millet is mildly goitrogenic, so you want to eat it in moderation.
This article was wonderful. It described exactly how I feel and the journey I have been on since I was diagnosed hypothyroid. Thank you for such a comprehensive article.
Hi Abigail, thanks for your comment. I’m glad this was helpful to you.
This article is awesome. I am hypothyroid and I am taking synthyroid. The numbers say that my condition is normal, but I still have symptoms. Another awesome piece of informaiton from this article was “Foods that Weaken Thyroid Function.” I eat raw broccoli and cauliflower all the time as a snack. I will have to cook it or find another afternoon snack.
Hi Mz Vee, yes raw cruciferous veggies can really do a number on your thyroid. I’m glad this article was helpful to you.
I am so grateful to have found this article! I am suffering from an autoimmune skin disease called Granuloma Annulare, and have had it since childhood. There is no reliable treatment for this disorder, which leaves purplish-red bumpy lesions on the skin. However, it has become increasingly apparent to me that, at times when my diet has been very “clean”, the disorder tends to become much more dormant. I have also known for years that my thyroid does not function as it should. Sounds more than coincidental to me. I am ready to attack this fully from a dietary standpoint and learn a new way of eating so that I can live a more healthful life.
Hi Jennifer, thanks for your comment. It is true that autoimmunity is an “umbrella condition” that can be addressed in a pretty straightforward manner. There may be different strategies for different manifestations/symptoms of autoimmunity — whether it’s Hashimoto’s, Granuloma annulare, lupus, MS, rheumatoid arthritis, etc. — but the underlying inflammation is manageable and the first place to start is the diet.
Thank you Life Time Fitness and thank you Jill Grunewald for this wonderful article. I was diagnosed with the four syllable Hashimoto thyroiditis about 17 years ago. I am 57 now. I have been on meds since then and figured I would always be. I suspected that I could have more energy, but didn’t know how to proceed. Many of the women and men in my family have thyroid issues. Now I have hope that there are things I CAN DO to improve my health. I will improve my nutrition and get feedback from my doctor with lab tests. Even if I have to continue the meds, I know the improvement in nutrition will have far reaching results.
Thank you for your comment, Libby. Yes, thyroid issues are largely hereditary and yes, there are things you can do to feel better, whether you’re taking thyroid meds or not. Diet is undoubtedly the first place to start.