I recently bought the Thyroid Series from Underground Wellness, because that is an area I don't know much and wanted to learn more about. The thyroid is absolutely crucial for out health, every cell in the body is dependent of its products. The originals can be accessed here.
Unfortunately I cannot post the videos, as it is copyrighted material, but I will post a summary of each episode, as I go through them - for your benefit, if you are interested in this topic and just want to have the meat off the bone.
The first episode is by Chris Kresser:
Thyroid Myths and Truths
1 - Thyroid Tests:
Normal range for TSH given on lab is too broad:
“corrected range” is 0.5 - 2 (2.5)
Range for T3 and T4 ok, but often not tested (T3 most important, as it is the active form)
Further problem is “total T4 and T3” vs “free T4 and T3” - hormones are bound to protein because they are fat-soluble (to be transported in the blood). If the cleavage from the protein doesn’t happen, no “free hormone” is produced and thus is unable to enter the cells (so normal TSH, normal total T4 and T3, but low free T4 and/or T3).
Why does this cleavage not take place? Incompletely understood: inflammation and stress seem to play a role (and dysfunction of the HPA-axis), as well as imbalances in sex hormones. So more of a systemic problem than a problem in the thyroid itself.
Thyroid antibodies - main cause of hypothyroidism in US is Hashimoto disease (thyroid antibodies) - specific antibody tests: thyroperoxidase antibodies, anti-thyreoglobulin antibodies (for Hashimoto) and TSI antibodies for Grave’s disease (autoimmune condition causing hyperthyroidism).
Mainstream medicine often doesn’t test for these antibodies, as the treatment is the same regardless. Functional medicine does treat autoimmune disorders.
2 - Iodine
Should people with Hashimoto avoid iodine? Possibly true. The idea came from the fact that when iodine is added to salt, rates of Hashimoto goes up, so everyone thought that iodine is triggering Hashimoto. Problem is that this view avoids the issue of selenium: these population where they introduced iodine were also selenium-deficient. Selenium protects against potential toxicity of iodine (helps convert hydrogen peroxide from thyroid hormone synthesis to water).
So when taking iodine one should also take about 200 mcg of selenium a day. Selenium has been shown to be beneficial to patients of Hashimoto even if they get enough selenium in their diet - as long as they don’t overdo it - 400 mcg total selenium per day).
Not recommended to track antibody levels too often - they tend to fluctuate a lot and paradoxically sometimes increasing antibody levels actually are a sign of improvement.
3 - Cruciferous vegetables
Are goitrogenic (cause goitre, swelling of the thyroid gland). Iodine is the main cause of goitre. Cruciferous vegetables in moderate doses have substances that inhibit the uptake of iodine into the thyroid. In high doses these substances inhibit the uptake of thyroid hormones, which is much more serious. Other goitrogenic foods - millet, soy, yucca, sweet potatoes.
However, cooking destroys some of these substances (so people with low thyroid function shouldn’t eat them raw): steaming destroys 30%, boiling and discarding water 90%. Fermentation actually increases the goitrogenic substances, but decreases nitriles, which are even more harmful for the thyroid. So overall fermentation is good.
How to supplement: Sea vegetables like kelp products. Problem is that for Westerners the main source of iodine is salt, but most health conscious people eat sea salt, which contains very little iodine. Or fish head soup. So avoid raw cruciferous and go easy on cruciferous in general, but don’t avoid them.Soy and millet should be avoided, as well for other reasons: millet is inflammatory.
4 - Treatment for Hashimoto: medication is enough
Thyroid medication is not enough for people with Hashimoto. Thyroid medication might be needed in many cases, but not as the only thing (which is what conventional medicine does). With the ongoing inflammation you loose thyroid tissue, where the thyroid hormones are being produced, and as far as we know this tissue doesn’t grow back. So often the goal may be not to get off the thyroid medication completely, but to minimise the dose.
But we also need to focus on the underlying problem, which is the immune dysregulation. There is a whole bunch of things that we can do: one is diet. We need to remove from out diet everything that aggravates the immune system, as a starting point an autoimmune paleo approach: eliminate all grains and dairy, eggs and nightshades, at least at the beginning, for at least 30 days. After that you can start to reintroduce these foods and see how you react.
The we want to do things that specifically balance the immune system, mainly targeting the T-regulatory cells: Optimising vitamin D levels (no fixed dose, test for 25-OH-vitamin D) to 30 - 60 range (Note: not very clear which unit he uses, there are two, if the one is used, it’s very low, if the other quite high, so most probably ng/ml). 2000 - 4000 U per day should be enough to replenish the stores. Sunlight might not be enough as inflammation suppresses the conversion of sunlight to vitamin D, as does obesity, skin tone and solar angle.
The next is glutathion, the master oxidant in the body. So we need to boost these levels up again - liposomal glutathion is the favourite. Or you can take precursors like N-ac-cysteine (NAC) or alpha-lipoic acid, whey protein etc. Another way is low-dose naltrexone, that boosts the internal production of endorphins, the feel-good chemicals. But a lot of immune cells have endorphin receptors, which suggests that they play a role in immune regulation. so having more fun and pleasure in life actually boosts the immune system. Naltrexone in low doses has no known side-effects or dangers.
Last part is the gut. Gut flora help regulate immune system as well. Butyrate has been shown to have a deep impact on the gut flora, so plenty of fermentable fibres (from sweet potatoes, yams, potatoes, onions, garlic, etc). Butyrate you can also get from eating butter. Another problem is leaky gut, some researchers even claim that a leaky gut is a precondition for an autoimmune disease. Healing the gut is absolutely crucial.
20 - 30% of people with Hashimoto never test positive for antibodies. Why is unclear. In those cases a thyroid ultrasound can be helpful to diagnose.
5 - Thyroid medication
Mainstream medicine normally treats hypothyroidism with synthetic T4, which makes sense, as you don’t want to give the active medication directly, where the body has no chance to regulate (if giving T4 the body can regulate the conversion). So there is a reluctance to give T3. But the problem is, what if the patient cannot convert T4 to T3 sufficiently? My approach in these patients would be to treat them with T3 (I give freeze-dried thyroid from pigs), conventional medicine might give “Armor”, which is a combination of T3 and T4 in a specific ratio.
That is the reason why people with Hashimoto fare better with the combo, because they have a problem converting. But that is not true for everybody - one treatment doesn’t fit all.
Another problem is the fillers. Many patients with Hashimoto have a strongly reactive immune system. So they might have to experiment with different medications. And people can try to take desiccated thyroid. Here you want to make sure that the animals have been raised naturally, grass-fed and without a lot of hormones, as they tend to accumulate in the thyroid.
How to find the right does? One thing is to track the lab results, TSH should come down to normal (that means below 2.5 - 2.2), that the free T3 is coming up. And there is symptoms, you will know that it’s too much when you feel like you just had 4 cups of coffee, feel hot, have diarrhoea, insomnia etc.
Testing usually is 4 - 6 weeks after a dose change, which should happen slowly.
6 - Can gluten make Hashimoto worse?
True. Incidence of gluten intolerance in people with Hashimoto is higher. Some studies have even shown that 6 months on a totally gluten free diet can bring antibody levels back down completely, with no other changes. It can totally reverse it.
Another study has shown that lactose intolerance is actually even more common in people with Hashimoto. In such patients restricting lactose normalised antibody levels too.
Unfortunately I cannot post the videos, as it is copyrighted material, but I will post a summary of each episode, as I go through them - for your benefit, if you are interested in this topic and just want to have the meat off the bone.
The first episode is by Chris Kresser:
Thyroid Myths and Truths
1 - Thyroid Tests:
Normal range for TSH given on lab is too broad:
“corrected range” is 0.5 - 2 (2.5)
Range for T3 and T4 ok, but often not tested (T3 most important, as it is the active form)
Further problem is “total T4 and T3” vs “free T4 and T3” - hormones are bound to protein because they are fat-soluble (to be transported in the blood). If the cleavage from the protein doesn’t happen, no “free hormone” is produced and thus is unable to enter the cells (so normal TSH, normal total T4 and T3, but low free T4 and/or T3).
Why does this cleavage not take place? Incompletely understood: inflammation and stress seem to play a role (and dysfunction of the HPA-axis), as well as imbalances in sex hormones. So more of a systemic problem than a problem in the thyroid itself.
Thyroid antibodies - main cause of hypothyroidism in US is Hashimoto disease (thyroid antibodies) - specific antibody tests: thyroperoxidase antibodies, anti-thyreoglobulin antibodies (for Hashimoto) and TSI antibodies for Grave’s disease (autoimmune condition causing hyperthyroidism).
Mainstream medicine often doesn’t test for these antibodies, as the treatment is the same regardless. Functional medicine does treat autoimmune disorders.
2 - Iodine
Should people with Hashimoto avoid iodine? Possibly true. The idea came from the fact that when iodine is added to salt, rates of Hashimoto goes up, so everyone thought that iodine is triggering Hashimoto. Problem is that this view avoids the issue of selenium: these population where they introduced iodine were also selenium-deficient. Selenium protects against potential toxicity of iodine (helps convert hydrogen peroxide from thyroid hormone synthesis to water).
So when taking iodine one should also take about 200 mcg of selenium a day. Selenium has been shown to be beneficial to patients of Hashimoto even if they get enough selenium in their diet - as long as they don’t overdo it - 400 mcg total selenium per day).
Not recommended to track antibody levels too often - they tend to fluctuate a lot and paradoxically sometimes increasing antibody levels actually are a sign of improvement.
3 - Cruciferous vegetables
Are goitrogenic (cause goitre, swelling of the thyroid gland). Iodine is the main cause of goitre. Cruciferous vegetables in moderate doses have substances that inhibit the uptake of iodine into the thyroid. In high doses these substances inhibit the uptake of thyroid hormones, which is much more serious. Other goitrogenic foods - millet, soy, yucca, sweet potatoes.
However, cooking destroys some of these substances (so people with low thyroid function shouldn’t eat them raw): steaming destroys 30%, boiling and discarding water 90%. Fermentation actually increases the goitrogenic substances, but decreases nitriles, which are even more harmful for the thyroid. So overall fermentation is good.
How to supplement: Sea vegetables like kelp products. Problem is that for Westerners the main source of iodine is salt, but most health conscious people eat sea salt, which contains very little iodine. Or fish head soup. So avoid raw cruciferous and go easy on cruciferous in general, but don’t avoid them.Soy and millet should be avoided, as well for other reasons: millet is inflammatory.
4 - Treatment for Hashimoto: medication is enough
Thyroid medication is not enough for people with Hashimoto. Thyroid medication might be needed in many cases, but not as the only thing (which is what conventional medicine does). With the ongoing inflammation you loose thyroid tissue, where the thyroid hormones are being produced, and as far as we know this tissue doesn’t grow back. So often the goal may be not to get off the thyroid medication completely, but to minimise the dose.
But we also need to focus on the underlying problem, which is the immune dysregulation. There is a whole bunch of things that we can do: one is diet. We need to remove from out diet everything that aggravates the immune system, as a starting point an autoimmune paleo approach: eliminate all grains and dairy, eggs and nightshades, at least at the beginning, for at least 30 days. After that you can start to reintroduce these foods and see how you react.
The we want to do things that specifically balance the immune system, mainly targeting the T-regulatory cells: Optimising vitamin D levels (no fixed dose, test for 25-OH-vitamin D) to 30 - 60 range (Note: not very clear which unit he uses, there are two, if the one is used, it’s very low, if the other quite high, so most probably ng/ml). 2000 - 4000 U per day should be enough to replenish the stores. Sunlight might not be enough as inflammation suppresses the conversion of sunlight to vitamin D, as does obesity, skin tone and solar angle.
The next is glutathion, the master oxidant in the body. So we need to boost these levels up again - liposomal glutathion is the favourite. Or you can take precursors like N-ac-cysteine (NAC) or alpha-lipoic acid, whey protein etc. Another way is low-dose naltrexone, that boosts the internal production of endorphins, the feel-good chemicals. But a lot of immune cells have endorphin receptors, which suggests that they play a role in immune regulation. so having more fun and pleasure in life actually boosts the immune system. Naltrexone in low doses has no known side-effects or dangers.
Last part is the gut. Gut flora help regulate immune system as well. Butyrate has been shown to have a deep impact on the gut flora, so plenty of fermentable fibres (from sweet potatoes, yams, potatoes, onions, garlic, etc). Butyrate you can also get from eating butter. Another problem is leaky gut, some researchers even claim that a leaky gut is a precondition for an autoimmune disease. Healing the gut is absolutely crucial.
20 - 30% of people with Hashimoto never test positive for antibodies. Why is unclear. In those cases a thyroid ultrasound can be helpful to diagnose.
5 - Thyroid medication
Mainstream medicine normally treats hypothyroidism with synthetic T4, which makes sense, as you don’t want to give the active medication directly, where the body has no chance to regulate (if giving T4 the body can regulate the conversion). So there is a reluctance to give T3. But the problem is, what if the patient cannot convert T4 to T3 sufficiently? My approach in these patients would be to treat them with T3 (I give freeze-dried thyroid from pigs), conventional medicine might give “Armor”, which is a combination of T3 and T4 in a specific ratio.
That is the reason why people with Hashimoto fare better with the combo, because they have a problem converting. But that is not true for everybody - one treatment doesn’t fit all.
Another problem is the fillers. Many patients with Hashimoto have a strongly reactive immune system. So they might have to experiment with different medications. And people can try to take desiccated thyroid. Here you want to make sure that the animals have been raised naturally, grass-fed and without a lot of hormones, as they tend to accumulate in the thyroid.
How to find the right does? One thing is to track the lab results, TSH should come down to normal (that means below 2.5 - 2.2), that the free T3 is coming up. And there is symptoms, you will know that it’s too much when you feel like you just had 4 cups of coffee, feel hot, have diarrhoea, insomnia etc.
Testing usually is 4 - 6 weeks after a dose change, which should happen slowly.
6 - Can gluten make Hashimoto worse?
True. Incidence of gluten intolerance in people with Hashimoto is higher. Some studies have even shown that 6 months on a totally gluten free diet can bring antibody levels back down completely, with no other changes. It can totally reverse it.
Another study has shown that lactose intolerance is actually even more common in people with Hashimoto. In such patients restricting lactose normalised antibody levels too.
