Transcription
Hi, welcome to the Thyroid Pharmacist Healing Conversations podcast. I'm your host, Dr. Isabella Wentz, PharmD, your Thyroid Pharmacist, and I'm so excited to have you here today with me.
I know that many of you that are listening know my story, but some of you do not. So, I was diagnosed with Hashimoto's in 2009 after almost a decade of some very confusing and debilitating symptoms, nine years to be precise. And I sought the advice of an endocrinologist. Now, there were things that I wish the endocrinologist would have told me on my healing journey that he did not. And so today, I would love to share with you 10 things that I wish my endocrinologist would have told me about thyroid disease. I hope this will be helpful on your healing journey, and I hope this will perhaps shorten your learning curve/healing curve so that you can start feeling better right away.
I started this podcast to have some healing conversations so that you could learn how to take charge of your own health. I'm not going to be doing any kind of gatekeeping, and I'm excited to share with you what works and what doesn't work, and what's worked for me, and what has worked for lots of clients that I've worked with and have supported through my books, and my online courses, and my group programs, and my consultations, and coaching, and research too. So today, let's talk about what we wish endocrinologists would share with thyroid patients.
So, number one, I wish my endocrinologist would have told me that thyroid medications can help with symptoms even in the early stages. Now, here's the thing. When I was first diagnosed with Hashimoto's and hypothyroidism, I "quote unquote" had subclinical hypothyroidism. That means that my thyroid gland was damaged to a point when my pituitary started recognizing that there were not a lot of thyroid hormones circling and was starting to raise the alarm. So my TSH, which is a pituitary hormone that responds to low levels of thyroid hormones, started getting higher. It started going up.
Now, this is what happens initially in the third stage of Hashimoto's. People start having a breakdown of thyroid function, and their body is no longer able to compensate. So, in the previous podcast, I talked about how there are five stages to Hashimoto's. The first one is the genetic predisposition, the second one is when the thyroid attack by the immune system starts, and then the third stage is when that sustained attack, attack against the thyroid gland, damages the thyroid gland enough that the flags are being raised, which is the TSH. So I was diagnosed in stage three of Hashimoto's, and at that point, my doctor told me that I could just wait and watch and see what happened, without telling me that if I started to take thyroid medications at that point, that I would one, feel better, and two, that would potentially slow down the progression of the subclinical hypothyroidism.
Now, most doctors will not give people thyroid medicine when they're in that subclinical stage. And just so that we're on the same page here, subclinical hypothyroidism means your TSH is above two but below 10, and your levels of thyroid hormones T3 and T4 are still "quote unquote" within the normal range. And most doctors will not give people medications at that point. They'll just say, "Wait. Wait for what? Wait until you just feel significantly worse." I think starting thyroid medications at that point would have made me feel a lot better. I had a lot of hair loss, I had anxiety, I had a lot of fatigue and cold intolerance, and my symptoms just kept climbing up, up, up.
This is especially important for people that struggle with mood-related issues, any kind of symptoms, and especially for women of childbearing age because research shows that a TSH even above like three can be problematic with higher rates of miscarriage, trouble conceiving, and poor fetomaternal outcomes. So I have found that starting thyroid hormones can make us feel better and potentially slow down the progression of the condition. So I'm a big advocate of starting thyroid hormones even in the early stages.
The second thing that I wish my endocrinologist would have told me is that I might need to try a T3-containing medication. So, the most common prescribed thyroid medication on the market, there are various brand names such as Synthroid, Levoxyl, and generics such as levothyroxine. This medication contains levothyroxine, which is another name for T4 thyroid hormone. T4 is one of the biologically active thyroid hormones. However, T3 is the more active thyroid hormone. T4 is known as a prodrug. That means it needs to be converted to T3 to be more biologically active.
Now, looking at my pharmacology homework and my pharmacology textbooks, that conversion takes place every single time in the textbook and on paper, right? T4, uh, an iodine is taken off by an enzyme known as a deiodinase, and then becomes T3. Now, this doesn't always happen in the real human body. There are things that the, the enzymes require to work properly. Some of them are nutrients, some of them are going to be, um, not being under a ton of stress. If we're under a lot of stress, they might take off one of the iodine molecules off of T4, but in the wrong spot, and they might end up creating something known as reverse T3, which binds thyroid receptors, but rather than activating them, actually like prevents T3 from getting in. So if T3 was the gas, reverse T3 would be like the brakes.
So this can happen when we're under a lot of stress, and there are things that can cause our bodies not to properly convert T4 to T3. These include aging, fasting, kidney or liver disease, liver backlog, pesticide exposure, radiation, I already said stress, soy, surgery, low ferritin levels, obesity, nutrient deficiencies including zinc, various medications, low progesterone, growth hormone deficiency, heavy metals, iodine excess. If you have a variation in the deiodinase genes, which 10 to 15% of people might have, even if everything else is perfect, their nutrients are perfect, they're still going to have trouble converting T4 to T3.
Now, there are T3-containing thyroid medications on the market. These include liothyronine, Cytomel, and compounded T3 medications. Some people need the addition of these medications to feel human again. So I know people will say they continue to have brain fog, fatigue, depression, hair loss, weight loss resistance when they're just on T4. You add in a little bit of T3, and all of a sudden their brain function comes back on board, their hair starts to grow back, they're losing weight effortlessly. And I think probably the most devastating thing for me is a lot of people get put on levothyroxine, and they continue to be, uh, depressed. And doctors a lot of times will send them to a psychiatrist, and they'll get put on antidepressants. Now, very knowledgeable psychiatrists will know that in many cases, treatment-resistant depression responds well to triiodothyronine, T3 hormone. And I have found so many people and have met so many people that lost decades of their lives to depression because they were on the wrong thyroid medication.
So what you can do is you can take T4, and you can get a medication of T3 as an add-on. So then you would be taking two medications, a T4 medication and a T3 medication. The other option is to get a, either a natural desiccated thyroid medication, sometimes called desiccated thyroid extract depending on who you ask, or a compounded T4 to T3 medication that's like one pill that contains both hormones. A lot of people do really well with those medications. Um, some brand names include Armour Thyroid that you may have heard of, and there's also the compounded thyroid medications.
So I wish I would have known that in the initial stages when I was diagnosed, that some people, many people, do better on that T3-containing medication. Doctors will say 10% of people feel better this way. The research will say 40 to 50%. In my experience, in speaking to and working with thousands of thyroid patients, I would say more than 90%. Maybe I have a biased audience, maybe people that's, maybe people that seek my advice are the ones that are not feeling well. So if you are here and if you're not feeling well, perhaps there's a chance that you might benefit from something like this.
The third thing I wish my endocrinologist would have told me when I was newly diagnosed with Hashimoto's is to go gluten-free. I had been a practicing pharmacist when I was newly diagnosed with Hashimoto's, and I was very interested in what I can do to make my condition better, how I could get myself into remission, potentially maybe not need medications or not need as much medications. And you know, really, I just wanted to get rid of a lot of the symptoms that I was having because I felt quite awful in my 20s, struggling with so many thyroid symptoms. And so I found some research that talked about celiac disease and how some people who had celiac disease and subclinical hypothyroidism, which is what I had when I was diagnosed, as well as Hashimoto's, going gluten-free helped them normalize their thyroid function. And I was like, "Oh, I wonder if this is something I need to do."
And so I asked my endocrinologist about this. And I was eating gluten at the time. He tested me for celiac disease and said I didn't have celiac disease, so I didn't need to worry about gluten. I listened to this advice, and for many years after that, I still continued to struggle with thyroid symptoms, as well as irritable bowel syndrome and acid reflux and carpal tunnel in both arms. I finally sought the advice of integrative medicine, and I ended up doing a food sensitivity test known as ALCAT. And I'm going to link that in the show notes. And it showed that I was sensitive to a variety of foods, gluten and dairy included.
Now, I was like, "Oh no, this doesn't work. My endocrinologist told me." And blah, blah, blah. And I decided to go gluten and dairy-free just to prove that it did not work, right? Just to be like, "Okay, I can check off this off my list. This, this test doesn't work." And yada, yada, yada. And so I went gluten and dairy-free. Within three days, my acid reflux went away. My bloating went away. I was like, really into fitness at the time, but I constantly had a belly, and I'm like, "Where did I get? How did I get a six-pack?" Like, where did this come from? And then my irritable bowel syndrome went away. And within weeks, my carpal tunnel went away. And I was like, "What is this voodoo?" Right?
And so I really wish that my endocrinologist would have told me to go gluten-free. This is one of the first things I recommend to my clients, and majority of my clients, I would say 88% of the time, they feel better gluten-free. A lot of times they say they can lose more weight, their energy improves, their bloating improves, anxiety, hair loss, acid reflux, brain fog, constipation, stomach pain. A lot of these things get significantly better just by going gluten-free. So, um, I really wish my endocrinologist would have told me that. And then one last thing, I do not have celiac disease, right? You do not need to have celiac disease to feel better gluten-free.
The fourth thing that I wish my endocrinologist would have told me when I was diagnosed with Hashimoto's and hypothyroidism is that diet can have a big impact on thyroid health. In my experience, I've seen people eliminate various symptoms and even thyroid antibodies simply through changing their diet. The biggest things I recommend are eating for blood sugar balance. So generally, that's going to be fewer carbs and more fat and protein compared to the standard American diet. And potentially doing an elimination diet to see what foods you're sensitive to. Gluten, dairy, and soy are the most common reactive foods.
The fifth thing that I wish my doctor would have told me when I was diagnosed with Hashimoto's is that using selenium, this tiny, tiny micronutrient, can actually help a lot of thyroid symptoms and reduce thyroid antibodies. The research has shown that using 200 micrograms of selenium per day over the course of three months can lower thyroid antibodies by about 40%. In my experience, what I've seen is that using selenium can actually lower antibodies, lower anxiety, and improve hair loss. This is like across the board what I see in my thyroid clients.
The other thing that's been really interesting for me to see in the last few years, new research has combined selenium with myo-inositol, where a dose of 83 micrograms of selenium is used and 600 milligrams of myo-inositol. The two are used synergistically, and that actually allows them to have a greater impact on symptoms and thyroid antibodies. And in those cases of subclinical hypothyroidism, this can actually normalize thyroid function. And I so, so wish I knew that when I was first diagnosed because potentially I could have avoided the use of thyroid medications just by using myo-inositol and selenium. So this is something that I try to really advocate for, and I try to really share about.
The sixth thing that I wish my endocrinologist would have told me is that Hashimoto's and iodine deficiency-induced hypothyroidism should be treated differently. So, some individuals might have iodine deficiency, and iodine is a required nutrient that's needed to make thyroid hormone. Now, in Western countries, public health officials had noticed that people who were iodine deficient developed hypothyroidism. So they decided to remedy that by fortifying our salt supply and other types of foods with iodine. And this has led to mostly a resolution of iodine-induced hypothyroidism. Like, people would have these like giant goiters on their neck, and children would have a lot of health challenges, and people would be, have intellectual disabilities because of this deficiency.
Now, this doesn't happen anymore. But what has happened unfortunately is, you know, kind of like you solve one problem, and there's the butterfly effect. So solving that iodine deficiency then led to other types of thyroid issues, most specifically Hashimoto's and autoimmune thyroid disease. So researchers have shown that excess iodine can, can lead to accelerated thyroid tissue damage, especially in the presence of a selenium deficiency. And so the rates of Hashimoto's have doubled, tripled, sometimes quadrupled in countries that add iodine to their salt supply. And some of the old-school doctors, like the integrative doctors, will say, "You have a thyroid issue, here's a whole bunch of iodine, take this, this, this will solve your problems." Fortunately, it doesn't work that way, and then people tend to feel much, much worse. So they might go from being like subclinically hypothyroid and maybe antibodies in the 100 range, and then their TSH jumps to 100, and their thyroid antibodies jump to the thousand range. I've seen many, many people in this situation where they become bedridden. It's quite devastating, and we have to really work on getting the iodine detoxed out of their system.
Iodine is a neurotherapeutic index nutrient. And so when it's too high, it can be problematic. When we don't have enough of it, it can be problematic. And there's a sweet spot for iodine supplementation when you have Hashimoto's and hypothyroidism. And that sweet spot is what's in a prenatal vitamin or a multivitamin. So anywhere from like 150 micrograms to 300 micrograms, it's going to be helpful for addressing iodine deficiency that you might have, and it's also going to be helpful for not exacerbating Hashimoto's. Now, if you see a practitioner that tells you to take a really high dose of iodine without talking about selenium status or gut health, that's a red flag for me.
Another thing that I wish my endocrinologist would have told me is my hair loss could be caused by low ferritin. Ferritin is an iron storage protein, and this is often times deficient in people with hypothyroidism and Hashimoto's. And you can have the perfect amount of thyroid meds in your system, specifically levothyroxine, but you're not going to be able to convert that or utilize it properly if you have low ferritin. And this can lead to hair loss. And so the optimal ranges for ferritin for appropriate thyroid function and for not losing hair and for growing new hair is somewhere between 90 and 110, generally speaking. This is something that you want to test for. You do not want to just willy-nilly give yourself iron because too much iron can be toxic. You know, I think I hope you're getting kind of the understanding here that we need nutrients and just the right amounts to really thrive, and too much can be toxic. So this is something I'm a big advocate for testing.
Another thing that I wish my endocrinologist would have told me is that I was not going crazy. So thyroid conditions can cause a lot of mood disturbances. In fact, anxiety is one of the first symptoms reported in people with Hashimoto's and hypothyroidism. And people can have anything from like depression, anxiety, obsessive compulsive disorder, bipolar disorder. I had new onset panic attacks. This is because as the immune system is attacking your thyroid gland, that dumps thyroid hormone into your body, leading to a transient hyperthyroidism. And so you get kind of put on this emotional roller coaster. And I really wish somebody would have told me that, like I wasn't crazy, that it wasn't, you know, something wrong with me with my mental health. Um, because I feel like a lot of people are put in like that mental health depression bucket. And I feel like that's a very important conversation. Mental health is super important, but so is finding the right diagnosis and the right treatment. If you have a thyroid hormone deficiency and that's causing your anxiety and that's causing your depression, then getting on antidepressants, maybe that might band-aid some of your symptoms, but that doesn't get to the root cause.
Number nine is, I wish that my endocrinologist would have told me that it's important to monitor my thyroid antibodies. Thyroid peroxidase antibodies and thyroglobulin antibodies, TPO and TG respectively, are two antibodies present in the majority of people with Hashimoto's, and they can indicate how aggressive the condition is, and they can also indicate if the lifestyle changes you're making are helpful. So if you are doing the gluten-free diet, if you're taking a selenium, and you see a drop in your symptoms and your thyroid antibodies, that gives you an indication that you're on the right path.
And number 10, your thyroid may function and work on its own again in the future. So there are a lot of conversations about thyroid function, it's just, you know, once it starts breaking down, there's nothing that can happen to help with regenerating thyroid tissue. Now, new research has shown that this is not the case. This wasn't available when I was initially diagnosed, so I can't be too mad at my endocrinologists for not knowing that, although there were some reports of thyroid patients who spontaneously had their thyroid function come back on board. But there are various therapies such as low-level laser therapy, and even using myo-inositol and selenium in the early stages that can actually help bring back thyroid function.
So this is my podcast, this is my soapbox, right? I'm so excited to be able to share this with you. This is the top 10 things I wish my endocrinologist would have told me when I was first diagnosed with hypothyroidism and Hashimoto's. I hope that this conversation can be a part of your healing journey. Stay tuned for additional episodes where I will be really talking about various symptoms and how to address them, how to reduce those thyroid antibodies. We're going to be going into detail on thyroid meds and some of the different root causes and triggers, and what you can do to take charge of your own health. Until next time.