Low thyroid: What to do?

8. February 2009 William Davis (25)
I've gotten a number of requests for solutions on how to solve the low thyroid issue if either 1) your doctor refuses to discuss the issue or denies it is present, or 2) there are government mandates against thyroid correction unless certain (outdated) targets are met.

Oh, boy.

While I'm not encouraging anyone to break the laws or regulations of their country (and it's impossible to generalize, with readers of this blog originating from over 30 countries), here are some simple steps to consider that might help you in your quest to correct hypothyroidism:

--Measure your body temperature--First thing in the morning either while lying in bed or go to the bathroom and measure your oral temp. Record it and, if it is consistently lower than 97.0 degrees (Fahrenheit), show it to your doctor. This may help persuade him/her.(You can still be hypothyroid with higher temperatures, but if low temperatures are present, it is simply more persuasive evidence in favor of treatment).

--Supplement with iodine 150 mcg per day to be sure you are not iodine deficient. This is becoming more common in the U.S. as people avoid iodized salt. It is quite common outside the U.S. An easy, inexpensive preparation is kelp tablets.

--Show your doctor a recent crucial study: The HUNT Study that suggests that cardiovascular mortality begins to increase at a TSH of only 1.5 or greater, not the 5.5 mIU usually used by laboratories and doctors.

--Ask people around you whether they are aware of a health practitioner who might be willing to work with you, or at least have an open mind (sadly, an uncommon commodity).

Also, see thyroid advocate and prolific author, Mary Shomon's advice on how to find a doctor willing to work with you. Yes, they are out there, but you may have to ask a lot of friends and acquaintances, or meet and fire a lot of docs. It shouldn't be this way, but it is. It will change through public pressure and education, but not by next week.

Another helpful discussion from Mary Shomon: The TSH Normal Range: Why is there still controversy? You will read that even the endocrinologists (a peculiarly contentious group) seethingly debate what constitutes normal vs. low thyroid function.

Also, you might remind a resistant health practitioner that guidelines are guidelines--they are not laws that restrain anyone. They are simply meant to represent broad population guidelines that do not take your personal health situation into consideration.
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Comments (25) -

  • P

    2/8/2009 5:24:00 PM |

    How about acupuncture and chinese medicine? Anecdotally, they will be able to help you through monitored use of chinese herbs and acupuncture.

  • Anna

    2/8/2009 5:49:00 PM |

    I'd also like to add that if one can't get good thyroid care inside an HMO network or "universal" healthcare system, it can be money well spent to go "outside" the system  for private care.  Granted, paying for non-reimbursable care isn't cheap and one has to do a lot of investigating to make sure one isn't paying for more of the same inadequate care (or worse care).  But I think too many people who can afford to pay for private care suffer needlessly by doggedly sticking to inadequate care because alternatives cause a financial dent.  But in the long run, if one can find good care even though there is added expense, it can save a tremendous amount of suffering, as well as saving money.

    When I was seeing a thyroid doc out of my HMO network, I was still able to get my lab work done by the HMO approved lab  and covered by my HMO insurance (the lab faxed the results to the out-of state doc without question), though the results did go into the computerized file at my HMO network, so was visible to any HMO doc.  And my HMO insurance Rx plan covered the conventional meds prescribed by the out-of-network doc without question (but not the compounded Rx).  Yes, it cost me a few hundred dollars a year to see the doc once year, a few telephone consults, and the non-covered compounded Rx, but it well worth it.  I was finally feeling and functioning better.

    And when I went back to my HMO eventually (mostly because of travel scheduling difficulties in seeing the out-of-state doc), I was in a better position to make a case for similar care with the HMO endo (I told him flat out I'd had trouble getting good thyroid care from primary care physicians in the HMO and so went "private" for a couple years, but wanted to find someone local in the HMO for convenience) .  He doesn't do compounded Rx, and typically prescribes only Synthroid, but he accepted that I prefered T3 with the T4 (and he "accepted" the "odd" way I adjust my T4 dose with different amounts of 50 mcg Levoxyl on different days to get an overall weekly dose that works - the 50 mcg tablet has no dyes added and he accepted that I preferred Levoxyl over Synthroid).  So for the first time with the HMO system, I feel my thyroid care is more of a team effort that includes my input, instead of being at the mercy of whatever is dished out to me.  And if the situation changes, I will promptly go outside the HMO again.

  • Nameless

    2/8/2009 6:27:00 PM |

    I would also suggest using the Armour site to look for prescriber's.  Their site has a little 'doctor finder' feature.

    It doesn't mean they'll necessarily treat you, but they tend to be more open-minded that doctors who prescribe Synthroid only.

    Most doctors won't use body temperature as a guide, by the way. And most won't treat Hashimoto's unless your TSH is >5. I know it's wrong, but that's how it is.

    Supplementing iodine may be helpful, unless you do have Hashimoto's, then it could make it worse (so you know). But you won't know you have Hashimoto's until you get your thyroid antibodies tested.

    A couple of other suggestions:

    Ask your doctor for Free T3/T4 AND thyroid antibodies. If your TSH >3 and your anitbodies are high, it really improves your odds of getting treatment. Many doctors ignore antibodies, but some do pay attention to them.

    If your TSH or antibodies are high at all, ask your doctor for a thyroid ultrasound. If the ultrasound is abnormal at all, it improves your odds of getting treatment too.

    Just going to a doctor with a TSH of 1.5-2.0 and normal T3/T4, it'd probably be close to impossible to get treatment. It really helps if you have the antibodies or ultrasound or something else to show the doctor.

  • Anonymous

    2/9/2009 6:33:00 AM |

    No person should break the law.

    However, there might be people within the arctic circle who don't have easy access to a physician who is willing to prescribe natural thyroid, including armour thyroid.

    What to do in a situation like that?

    One solution:  Find a site on the internet that provides for ordering and shipping thyroid, including Armour Thyroid, without a prescription.  There is at least one site that can be found via google that will do this.

    Warning:  There are significant dangers in supplementing thyroid without being under a doctors care.

  • Dr. William Davis

    2/9/2009 12:50:00 PM |

    Thanks, Anna.

  • Anonymous

    2/9/2009 6:13:00 PM |

    Regarding the thyroid issues Dr. Davis has been commenting on lately, and wondering why it seems so prevalent, have you considered the possibility that diet is playing a role.

    And when I say diet, it's probably not in the way you think --

    Carbohydrate restriction can lower thyroid hormone output, especially conversion of T4 to T3. Those who practice caloric restriction tend to have lower levels of T3 too.

    If Dr. Davis is seeing somewhat low, but still in 'normal' range T3/T4, with perhaps sluggish T3 levels, in patients AFTER they change to a no wheat, low carb diet, perhaps that is the reason why? Or perhaps that's why Dr. Davis' own thyroid had somewhat sluggish numbers?

    But if people all have high thyroid antibodies too, or all have crummy thyroid levels while eating tons of carbs, that wouldn't be a reason then.

    Just throwing that out there to think about.

  • Don

    2/9/2009 6:49:00 PM |

    for those who are willing to do the research and check their tsh levels then ordering online is an option. start with a low dose 15 to 30 grains and then ck your tsh. Increase dose to normnal tsh levels.  There are multiple sites for armour and synthoid that do not require a prescription. When you take this road to self medication you must realize you are toally responsible for your actions and well being. Be sure you know what you are doing
    Don

  • Anna

    2/9/2009 8:14:00 PM |

    Lately I've been giving a lot of thought to the LC packaged foods that many people turn to when they first embark on a LC diet, such as low carb breads, crackers, etc.  For me, it was LC pita bread a few years ago, before I essentially went grain-free.  These products, in addition to usually having a lot of soy in them, also have added wheat gluten, to reduce the starch and boost the protein content.  Low carb they are, and generally will help with the BG control and overall weight reduction or maintenance.

    Both gluten-containing and soy foods are relatively new foods to the human diet (only consumed since the age of agriculture) and modern industrial processing bypasses many of the steps that earlier humans took to render them safer to consume.  Soy can be a powerful thyroid inhibitor (goitrogen)  and gluten can trigger an auto-immune response in susceptible people (genetic predisposition to gluten sensitivity is much more common than previously thought, though how widespread is subject to debate).  There does seem to be a strong connection to autoimmune thyroid conditions and issues with gluten.

    So people who eat a lot of soy and gluten-enhanced LC foods might be literally be shooting themselves in the thyroid, especially those who overconsume  consume them (dieters don't ever become overzealous, do they?  Smile), instead of foods that are naturally low carb and/or have a longer history in the human diet.

  • Anonymous

    2/9/2009 8:18:00 PM |

    I think ordering prescription medication over the internet from a less than reputable pharmacy, without a prescription, is a real bad idea. And if they don't require a prescription, that pretty much automatically makes them less than reputable.

    And don't assume thyroid medications are completely benign. They can have side effects too.
    And especially in patients with heart disease. You have to be titrated slowly and need to be under a doctor's care.

  • Lou

    2/10/2009 8:28:00 AM |

    DIY Armour/NTH treatments can be troublesome. If you are suffering from adrenal fatigue, starting immediately on thyroid replacement can cause heart palpitations and other symptoms of physical and mental anxiety. If you have low cortisol and DHEA (they invariably go together), you will probably need to take a low-dose steroid and/or DHEA replacement for a month before beginning thyroid. It is best to get these things tested first, even if you have to do it on your own. I think the Stop The Thyroid Madness author has put together some lab test packages for people to get the right things tested. And when you're taking the replacement steroids and hormones, you need to keep monitoring your levels every month at first, then every three-four months once you stabilise.

    Google for the "Top Thyroid Docs" list by Mary Shomon for sympathetic doctor suggestions/review.

  • Lou

    2/10/2009 8:33:00 AM |

    I forgot to add, the thyroid books by Dr Broda Barnes are good reading, easy to understand if you're a layman too. He had one on incidence of heart disease in patients with corrected thyroid function which is very interesting. I don't recall he mentioned wheat, but he certainly believed that we should eat good old saturated fats like butter, lard, coconut, etc, to support good health and thyroid.

  • Trinkwasser

    2/10/2009 1:19:00 PM |

    Anecdotally along with the iodine I've heard a brazil nut per day suggested for the selenium. Where I live is not selenium deficient, thanks to the end of the Ice Age glaciation: this is reputed to be one reason for the longevity here. Next time I catch a doctor I'll ask if there's much thyroid disease here (they will diagnose and treat here, my TSH was 0.99 so something is working!)

  • Anonymous

    2/10/2009 1:40:00 PM |

    That iodine dose may still be too low. Remember the RDA was set at a level just to prevent goiter, not for optimal health. Check out www.breastcancerchoices.org.
    Healthy Japanese get 12.5mg (12500 mcg) of iodine per day. Probably we are all low in iodine and bromine competes for binding sites. Bromine is ubiquitous in our chemically laden environment and is used as a dough conditioner by commercial bakeries---they used to use iodine. The thyroid gets the bulk of our low iodine but it turns out that iodine is also concentrated in our gonads, adrenals and especially the breasts. Our epidemic of breast cancer and fibrocystic disease may be due to iodine deficiency.

  • Saint Patrick

    2/10/2009 5:46:00 PM |

    If you cannot get this treatment on HMO, then you should look at going private. Believe me, it is not something that you can ignore

  • Eichler

    2/10/2009 7:52:00 PM |

    Dr. Davis,

    I realize that you aren't in the business of diagnosing ailments or conditions via the internet, but I've recently experienced some hypothyroidism symptoms (low body temp. average of 96.7, fatigue, weight gain, hair loss, etc..) that my Doctor insists are unrelated to the disease.  In addition, he has also just put me on a combination of Crestor and Trilipix for an abnormally high triglyceride reading, despite this reading being a one-time fluke.

    My labs are as follows:
    TSH:       2.761
    Thyroxine (T4): 6.4

    He was not interested in doing any more thyroid testing beyond these two.

    Lipids:
    Total Cholesterol: 165
    Triglycerides:     415
    HDL:               22
    LDL:               N/A

    After a week on the Crestor (10mg) / Trilipx (135mg) combo, I was stricken with muscle aches and pains, tinnitus, popping ears, dizziness and a foggy out-of-it feeling.  After two weeks and finding your site, I discontinued the use of the two cholesterol medications against the Doctor's advice.  I've since starting taking an Omega 3-6-9 supplement three times daily along with my daily multi-vitamin.  I also take diazide/HCTZ for slightly elevated BP (130/96) and have recently begun following a strick low-carb diet and exercise routine.

    Again, I don't expect a diagnosis from you, but would appreciate if if you could voice your thoughts on the viability of me continuing to find a doctor willing to be more open minded to thyroid issues as well as pursuing more natural remedies to lipid issues.  

    Thanks for providing such a valuable resource for those of us who are getting fed up with the flawed standard of care that is currently being forced on so many people.



    My labs show the following.

  • Dr. William Davis

    2/10/2009 9:13:00 PM |

    I agree on the iodine dose question.

    The difficulty comes in trying to generate conversation through the blog for people who may or may not, for instance, have underlying Hashimoto's thyroiditis or thyroid nodules, in which case taking higher doses of iodine can trigger extreme excesses of thyroid hormone.

  • Anonymous

    2/10/2009 10:14:00 PM |

    I had been on Sythyroid for a few years but no one had ever mentioned or tested for Hashimoto's. Still feeling horrible, I found a holistic MD, and was diagnosed with Hashimoto's and started on Armour.
    Do I still have Hashimoto's or is it quiet now that I am taking a different hormone?
    The holistic said it would "kill" my thyroid and move on to another area, like adrenals.
    I did have a positive ANA for many years and tested for Lupus, RA, etc. many times. Then routine testing showed my ANA had returned to normal values.  
    Any ideas because my current endo. sure isn't forthcoming with any and doesn't/hasn't tested for antibodies.  He feels I am just hypothyroid.
    I appreciate all your information!

  • Nameless

    2/11/2009 5:20:00 AM |

    To test for Hashimoto's you need your TPO and TGAB antibodies tested. If they are above normal range, you probably have it. The definitive diagnosis is via a biopsy, but without a nodule that isn't usually done. An ultrasound is another diagnostic tool -- if your thyroid looks enlarged, nodular or all lumpy, along with antibodies, it's pretty safe to say you have Hashimoto's.

    I have never read, or heard of, Hashimoto's 'attacking' other organs after your thyroid is burnt out. That theory seems a bit out there to me.

    Antibodies can fluctuate, and with thyroid hormones usually become lower over time.  Inflammation tends to be reduces with hormones too.

  • Trinkwasser

    2/11/2009 4:13:00 PM |

    OK I caught one of our GPs yesterday, the selenium in the soil connection appears to be a non-starter. Her experience was that she found hypothyroid "quite often" predominantly in post-menopausal women and with incidence increasing with age. It's impossible to compare numbers with other areas since they actively look for the condition here and don't elsewhere. Also we have a lot of local longevity so more patients with systems wearing out purely through ageing.

  • Anna

    2/14/2009 12:27:00 AM |

    I always wonder about something I hear frequently - the issue of "soil mineral depletion".  Not that it isn't possible, but how significant is this and how widespread?  People don't generally eat "locally" produced food anymore; food supplies are distributed from all over the globe now, though agriculture is quite intense in some places, like the Central Valley of California, or cornfield in Iowa.  Wouldn't the shipping of food products all over sort of "average out" the minerals like iodine and selenium?  Or are  all the major agricultural regions of the world growing with depleted soil propped up with little more than NPK replacement?  

    I'm actually more into local, seasonal organic food than worldwide food.  LIving near the coast, presumably there is adequate iodine in the soil, but here I am, hypothyroid anyway.  Just wondering...

  • Trinkwasser

    2/15/2009 3:47:00 PM |

    Hard to tell about the soil mineral depletion thing, there are major regional variations which can show in animal diseases and require supplementation, salt licks etc. as well as human disease clusters. Deficiencies can show before "deficiency diseases"

    I trialled several different supplements but none of them made any discernible difference, probably a widely varying diet helps, plus fish, and local farmers who use high levels of organic manure and feed the soil as a whole rather than (increasingly expensive) stuff out of a bag and treat the soil as a sterile growing medium. Grass-fed rather than grain-fed meat, and game, probably helps too in picking up trace elements

    The downside of World Trade may be that while you get more trace elements from crops from different regions you are probably also getting more pesticides some of which are banned in the West

  • roaminghermit

    2/20/2009 8:35:00 PM |

    I've been doing so great after taking 1 1/2 gr nature-Throid brand of thyroid since october 08 and stopping all statins. Taking the Now D-3 at 5,000 per softgel. Now if I can just get back in the forums again....LOL   Dennis  still no 4th heart attack since 12/04

  • Laura

    3/14/2009 6:44:00 PM |

    I wish my family doctor was open to new things. I asked him about Armour thyroid he said that he has hundreds of patients on Synthroid with no problems and I don't want to start a new prescription without my family doctor knowing about it. I'm on 75mcg of Synthroid and would really like to try Armour thyroid...might have to wait until he retires (could be soon) before I see if I can get Armour..

  • Jessica

    5/8/2009 1:23:00 AM |

    Dr. Brownstein (Family physician, holistic doc in Michigan) in his book, "Iodine, Why You need it, Why You can't live without it" makes an interesting case for temporarily increased TSH (5-30mU/L higher) after correcting iodine deficiency.

    In addition to just stimulating thyroid hormone production, TSH also increases the production of the iodine transport cells (NIS). Without more NIS available, iodine couldn't enter the cells and be utilized. Therefore, increased TSH makes sense during the initial phase of iodine correction.

    As one increases their iodine consumption, they could experience this increase in TSH for as long as several months. As long as the T3 and T4 levels are normal, then the TSH elevation probably isn't a sign of hypothyroidism.

    If you haven't yet read this book, it's worth the 2 hours it took me to get through it.

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