Low T3 Syndrome IV: An Autoimmune Disease You’ve Never Heard Of?

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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

In the last article in this series I discussed several lines of evidence suggesting that inflammation is one of the primary causes of Low T3 Syndrome.

In this article we’re going to discuss another common, but lesser known, cause: autoimmune hypopituitarism.

Say what? I know that’s a mouthful. Let’s break it down.

The pituitary gland is located just below the hypothalamus, but outside the blood-brain barrier. It’s primary job is to monitor the levels of hormones produced by various endocrine organs (like the thyroid), and release stimulating hormones (like TSH) that direct those organs to produce their respective hormones (like T4 and T3).

The pituitary gland can be the target of inflammatory response to local infections, cancer or autoimmune reactions. When an autoimmune mechanism is involved, lymphocytic adenohypophysitis (LAH) or autoimmune hypopituitarism are the terms used to describe the condition. (I’ll refer to this condition as LAH throughout the article.)

What is autoimmune hypopituitarism?

LAH is characterized by progressive destruction of pituitary tissue, which over time produces a decline in the function of the pituitary gland. (1) When the pituitary is damaged more than one hormone is affected, especially as the disease becomes more advanced.

It was originally believed that LAH occurred exclusively in pregnant women. (2) But although prevalence is still much higher in that population, we now know it also occurs in non-pregnant women, men and children. (3)

Adrenocorticotropin (ACTH) deficiency is most common (60%), followed by thyrotropin (TSH) deficiency (47%), gonadotropin (FSH/LSH) deficiency (42%), growth hormone deficiency (42%) and prolactin deficiency (34%).

What is remarkable about this condition is how unknown it is in spite of its prevalence. It’s true prevalence is unknown, but most investigators believe it is under-reported because it is often misdiagnosed. I’ve seen some estimates that it may affect up to 0.5% of the population and up to 40% of Hashimoto’s patients.

How is autoimmune hypopituitarism diagnosed?

The reason it’s so often misdiagnosed is that it’s difficult to pin down. It is strongly associated with other autoimmune diseases, which further complicates the clinical picture. In fact, concurrent autoimmune conditions are reported in 20-50% of LAH cases. (4)

Interestingly, Yoon et al. injected hamsters with Rubella virus glycoproteins and consistently induced LAH, as evidenced by autoantibodies to pituitary cells and infiltration of the pituitary gland by lymphocytes. (5) This finding suggests there may be some connection between viral infections and LAH.

Other investigators have identified antibodies to growth hormone (GH), thyrotropin (TSH), and luteinizing hormone (LH) in cases of LAH. (6) Unfortunately, the only conclusive test for LAH is a tissue biopsy, which is obviously problematic due to the location of the pituitary gland.

Low levels of the pituitary hormones can indicate LAH, but they can also be a sign of other functional problems with feedback in the hypothalamus or a primary problem with the hypothalamus itself.

What are the signs and symptoms of LAH?

The hallmark sign of LAH is atrophy of the gonads, adrenals and thyroid gland. Endocrine tissue is similar to muscle tissue in the sense that it will atrophy if it’s not stimulated regularly (similar to how men who take testosterone have shrunken testes).

Symptoms include:

  • Headache
  • Impaired vision
  • Nausea
  • Weakness
  • Loss of appetite
  • Hormone imbalances
  • Hyperprolactinemia

However, LAH is difficult to characterize because it can mimic so many other conditions. A problem with the pituitary gland can affect the entire endocrine system, because the pituitary sends out the stimulating hormones that direct the organs (thyroid, adrenals, ovaries, testes, etc.) to produce their respective hormones. This is, of course, how LAH can lead to low T3 levels.

It’s also interesting to note that there appears to be a connection between LAH and celiac disease. (What isn’t connected with celiac disease?) Delvecchio et al found that about 40% of newly diagnosed celiac patients had anti-pituitary antobidies in their blood and it resulted in – at a minimum – growth hormone deficiency. (7) This is an important finding that I have rarely seen discussed.

How is autoimmune hypopituitarism treated?

Not very well, in the conventional model. Some doctors use immunosuppressants like prednisone, azothioprine and methotrexate, but the risks and side effects of these drugs can often be worse than the disease itself.

The first step to take is to make sure you’re eating a diet that is free of foods that tend to provoke an autoimmune response. A Paleo-type diet is the best starting place, but you may also want to remove dairy, nightshades and eggs for at least 30 days because those foods can be problematic for people with autoimmune disease.

It’s also important to focus on nutrients that support proper T-regulatory cell function, like vitamin D and glutathione, and nutrients that support overall immune health like vitamin C, iodine and selenium.

I would also consider low-dose naltrexone (LDN), a medication that is being used to successfully treat a wide range of autoimmune diseases – including Hashimoto’s and Graves’. In most cases I don’t recommend pharmaceuticals because they tend to suppress symptoms without improving function. LDN, however, actually improves the function of the body by upregulating endogenous endorphin production and balancing the immune system.

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Comments Join the Conversation

  1. says

    I have taken synthroid for 32 years and it appears that my T3 has been low for the last few years when i was looking back over my lab results. I have had gut issues for the last 8 years and sleep issues being exhausted in the morning.I also get migraines but not as often as I used to. It is just that my muscles tighten and do not release. Gluten free helped the body pain leave a few years ago. I am mostly vegetarian but wonder if i am getting enough protein in my diet. I have been giving myself B12 shots which I feel has helped. My question is can Hashimoto ( hypo thryroid) people take Naturthroid or Armour? I was told it was animal product and that one should not. I had adrenal fatigue or burn out and am still coming back from that. I think it is a life long project. I am 62 but exercise daily and have lots of energy at times but certainly not in the morning. Sleeping through the night would help.Thanks you for any advice reguarding the thyroid medicine. Can you split the synthroid in two and take half in the middle of the day also? Would this help? Thank you!

  2. carol says

    I had been on synthroid for49 years. had a goiter when I was 18 and had all but 2% of thyroid gland removed. been up and down for quite some time. recently like with a month tsh went up to 34 by increasing synthroid. got off of that and was on t3 meds only and could not tolerate. currently off everything. going for another test however, I am good for one week then feel the lump in my throat and it starts again. I exercise everyday on a body vibrator eat pretty much paleo. what next? am on many supplements !

  3. Hayley long says

    Hi, i have been chronically unwell for roughly 2-3 years now. Blood tests after blood tests, gynae consults, endoscopy finding chronic gastritis, upper and lower abdo ultrasound all clear. Laat blood tests showed b12 levels of 106 so had 6 injections, followed by more blood tests to check for celiac and autoimmune pernicious anaemia. All tests have returned normal and am back to square one.
    Chronic fatigue, IBS symptoms, depression, night sweats, weight loss/anorexia, insomnia, chronic back pain, intermittent frequently needing to urinate way more than am drinking. So now my gps have cut me adrift again. I’m convinced there is a pituitary/adrenal/autoimmune link but cant get my docs to take this further as my tests are within range. Do any here recognise these symptoms abd what would you advise. In the uk our primary physicians are bound by guidelines for referring and as i am “normal” no referral. Would it be worth me going to see a private physician and in what area if so.
    Many thanks for reading this, im only 32 with two young kids and need my get up and go back as it has gotten up and gone..

    • says

      Dear Hayley, as a UK person too, I really feel for you up against our narrow and dreadfully limited NHS. So frustrating!
      You didn’t mention anything on the diet front that you have done, so here I just want to suggest that you get off all cereal grains entirely. That means not only those with gluten in (obviously) but also those that sport the label ‘gluten-free’. The truth is NO grains are gluten free, even the pseudo-grains, like buckwheat and quinoa cause autoimmune reactions in some people, and you won’t know if you are one of those unless you get off them all, entirely. Sensitive people also can react to any of the beans, i.e. all the pulses (though lentils seem to be the least reactive) and even coffee. Yup, it’s a bean. Chocolate could also trigger an immune reaction, but that is even less usual, except in those with migraines where it is a know trigger (and I have not followed up all the ins and outs of this one). Also there is often a cross reaction with casein, i.e. the protein in all dairy products. Indeed 50% of people with reactions to glutens/gliadins and other proteins in cereal grains also react to casein. So, get yourself on a diet free from ALL CEREAL GRAINS, ALL PSEUDO-GRAINS, ALL DAIRY PRODUCTS. It sounds like a lot to change but lots of great things are IN, such as meat, fish, eggs, offal, shellfish, all vegetables (apart from potatoes in any sort of quantity) and all sorts of fats and oils other than the yellow bottles of ‘vegetable oil’ of any sort as these are very inflammatory, being high in omega 3 fatty acids.
      If you want to know if you have any reactions to any aspect of cereal grains before you take on the not inconsiderable changes to your diet, I recommend you get tested via Cyrex Laboratories. You can only get these through a practitioner who is signed up with them (as I am) as they offer by far the best testing for reactions to grains, to dairy, to cross reactions to other things and far far more. I wouldn’t bother with any other tests or laboratories for reactions to grains as they are simply not good enough (in my humble opinion). Other labs are good for some things, great in fact, but Cyrex definitely do the best tests for reactions to cereals and cross reactions, including reactions in the nervous system, which can manifest as depression, schizophrenia, bipolar, and the whole autistic spectrum (though that is not all there is to autism of course).
      Cyrex have only recently become available in Britain, as they are an American lab, but have just opened up offices in Surrey and Ireland. (The Irish have very high rates of reaction to cereal grains).
      Good luck with it.
      Afifah

  4. Anetha says

    I have was so very I’ll for a month and am a little better now but have Hashi and had been in the hyper stage for 3 years now even though test were coming back jus slightly hyper. The lasts 30 days was I. ER twice with horrific headaches, heart palpitations, rapid heart rate and stomach pain. Of course they treated it like a cardiac event and when they realized I wasn’t having. Heart attack sent me home. Went to an Internist who did blood work and my TSH, free T4 and free T3 were all suppressed. She thought it was my Pituitary and referred me to Endocrine Specialist who didn’t examine me at all and told me to stop taking my Cytomel (25 mcg) for a month and have blood draw. My BP which has always been normal was starting to shoot up and down. He ignored this and all my other symptoms i.e. Neck swelling, fever, insomnia, blurred vision, etc. I thought I was dying I felt so bad. I went home and did as he said. Was only taking 100mcg synthroid a day and waited a little over 30 days. During this time I gained 17 lbs, got depressed, was hot all the time and not sleeping in addition to my remaining symptoms, got blood work today and still TSH and free T3 are suppressed but Free T4 is up to 1.32. Still have not heard from Dr. What is your thoughts? It is so hard to work in this condition. Am exhausted and foggy. Luckily I work from home so blessed in that regard.
    Thanks for all you do for us,
    Anetha

  5. Melanie says

    Hello Chris

    I have many symptoms listed you mentioned and others within this conversation. My question is if there has been a link to autoimmune hypopituitarism and a pituitary adenoma tumor?

    Thank you
    Melanie

  6. Km says

    Chris,
    First and foremost, THANK YOU! Your posts are very informative and well written.

    In your research, have you come across low T4, normal/low T3 and low TSH? I found one source that linked it to adrenal fatigue, where the adrenals are down regulating the thyroid. I am curious on your take.

  7. Kay Cee Anderson says

    I have used LDN very successfully for Hypopituitary and Hashimotos. We tested hormones after only two weeks and many tested at NORMAL levels! I had already recovered from Fibromyaligia with Exercise, Supplements for MTHFR, Autoimmune Diet, and HRT. LDN was the icing on the cake! So much has improved. Now I have to keep all these balls in the air! ;-) Still, I have a full life now. Love you for all your support Chris! I have listened to every podcast as I cook my way to AIP health! You are fabulous darling!

  8. Amy says

    I am so happy to see this post. I was diagnosed with resistance to thyroid hormone, hashimoto’s, fibromyalgia, chronic fatigue and thyroid cancer. All my symptoms have gone away with low dose naltrexone and high doses of T4/T3 thyroid drugs. I hope other people suffering from the autoimmune disease can experience a full recovery like I have using these drugs. Many doctors are reluctant to prescribe T3 and T4 drugs to those who have no visible hypothyroidism showing up in their blood. Only three years into treatment did I finally receive a diagnosis of hashimotos. I have sent two friends to my doctor who were diagnosed with chronic fatigue syndrome. They have experienced full recovery using T3 and T4 drugs even though they both had no thyroid dysfunction on their blood tests. If someone has all the symptoms of hypothyroidism, I do not understand why doctors would refuse a trial of thyroid drugs. Luckily, I found a doctor who was willing to treat my hypothyroid symptoms with these drugs. Dr. John Lowe wrote a book called The Metabolic Treatment of Fibromyalgia which discusses the recovery of many patients using T3 and T4 drugs, even though the patients show no thyroid dysfunction on blood tests. I hope the medical community will catch up one day to Dr. Lowe’s research.

  9. David L. Yusten says

    I am a 55 year old male have Fibromyalgia / Celiac Disease Manny autoimmune issues Thyroid Low T3 and I believe likely is very Hypopituitarism issue or related to my pututitary gland is the cause of my low T3 T4 and free T3 am taking compounded thyroid meds .

  10. Byron says

    I am going through a somewhat similar situation. Thyroid Peroxidase showed to be high at 65 and Thyroblobulin at 18. The nutrionist said those antibodies pointed to Hashimotos, so put me on Thyroplex and Iodoral daily. Didnt I understand Chris as saying do not take iodine if in this state of having those antibodies (Hashimotos)?

  11. Lynne says

    Why in the world would you recommend naltrexone? I just looked it up and it is used for people trying to get off drugs and alcoholics trying to stop drinking!

    • says

      Full strength Naltrexone and Low Dose Naltrexone (LDN) are not the same. The low dose helps people significantly with many types of diseases. Might want to visit LDNInfo.org to find out about LDN

      David Gluck, MD, says, “LDN is absolutely unique. And that’s part of its problem, in that it’s a brand new paradigm, a new way of thinking of treatment. Instead of the medication actually doing the work, LDN goes into the body and essentially tricks the body by forcing it to double and triple its output of endorphins and metenkephalin, also known as opioid growth factor (OGF). Those endorphins and metenkephalin, in turn, cause the immune system to strengthen. A nice way to think about LDN is that it is not like any other medication whatsoever. It is a way to strengthen the immune system.”

  12. Christina Arasmo Beymer says

    Low Dose Naltrexone (LDN) would help you a lot, or it does most people. Whatever your health issue, it “essentially tricks the body by forcing it to double and triple its output of endorphins and metenkephalin, also known as opioid growth factor (OGF)”. This will help your health in a number of ways, among them is reduced inflammation and regulation of your thyroid hormones. LDN helped my mother survive a grade four Glioblastoma brain tumor and now she’s on the mend from the horrible radiation they gave her.

    ***As long as you are not taking any type of opiate pain killers (make sure of this)***, you can take LDN. If you need help in locating a doctor to prescribe or, you can compound your own, contact me here https://www.facebook.com/lowdosenaltrexone

  13. georgia says

    I have no diagnosis;6 yrs. now with all kinds of bone & joint pain & tons of other pains. Dr wants to keep giving me these meds that made me worse than better & can kill 5 ways. I don’t want the meds anymore. I take Neurontin 2X daily & it helps. Can’t sleep, trouble walking or sitting. Use my arms or legs or hands and they start hurting or freeze up. I have carpal tunnel too. I’m too old to come down with these things now, and you all are so young to have to cope with all the hurting. I am interested in the SCeNar machine & it’s cost. I want to feel better, faster than the more than 6 years I have felt like I was beat with a bat daily. georgia

    • Christina Arasmo Beymer says

      Low Dose Naltrexone (LDN) would help you a lot, or it does most people. Whatever your health issue, it “essentially tricks the body by forcing it to double and triple its output of endorphins and metenkephalin, also known as opioid growth factor (OGF)”. This will help your health in a number of ways, among them is reduced inflammation and regulation of your thyroid hormones. LDN helped my mother survive a grade four Glioblastoma brain tumor and now she’s on the mend from the horrible radiation they gave her.

      ***As long as you are not taking any type of opiate pain killers (make sure of this)***, you can take LDN. If you need help in locating a doctor to prescribe or, you can compound your own, contact me here https://www.facebook.com/lowdosenaltrexone

  14. kelly says

    hi chris, first off, thank you so much for all this wonderful info.
    i have quite a complex situation going on and would love your advice. i have hashimoto’s and have been on synthroid for 10 years. i am 28, i also have ankylosing spondylitis, celiac and possible lyme (waiting on results) my thyroid has gone nuts over the past 4 months.. at least i think it is my thyroid. i tested with low t3, very low tsh and normal range t4. so i cut back synthroid and added a little bit of compounded t3. this made things soooo much worse. my heart beat very hard, and slow, i felt intense panic all the time, my hair continued to fall out, i would get sudden extreme fatigue almost like i was losing consciousness.. confusion, paranoia..memory loss etc etc. so i stopped that and felt a lot better. after a month i retested my thyroid and found out i have very high reverse t3.. i can not go on the t3 only protocol yet because my b12 and ferritin are low, i also do not know the status of my adrenals.. i am assuming they are not doing so well. my doc and i thought i could try out armour thyroid in the meantime to see if that helps more than the synthroid. i tried it for 3 days and felt that same awfulness that happened with the t3 before. (i also recall trying armour and cytomel years back… they felt awful back than as well).
    i stopped taking the armour and am back on the synthroid.. i have no idea what to do, or what is going on?? i am on a super clean diet, all organic, starch free, dairy free, sugar free… i have been out of work for almost four months and am having to apply for disability, i am totally broke and can not afford to keep seeing my naturopath. i have no idea what to do anymore.. i would love your advice if you have any.
    also, i am totally exhausted trying to figure this out on my own.. it has totally consumed my life for the past 5 months and i dont know how much longer i can do this. its a full time job, and all the obsessing does not help either. my chronic pain from the AS is really secondary compared to all this mental stuff that has occurred, that is what scares me the most.. the loss of my clarity and functioning intellectually.
    i have also started low dose naltrexone about a month ago, it helped at first, now i am back in the hole.. i think i have candida and am on nystatin to hopefully clear that up.
    sorry such a lengthy post

    • Lauren says

      Hi – I can totally relate to not tolerating T3 medication very well. How are you doing now? It would be great to hear if you have any good advice on this, or if you still have not been able to find a resolution. I am in the middle of it all, so we’ll see how it goes! Thanks.

    • Jayne says

      I have Hashimotos, and been on natural thyroid for years. Recently my health practitioner detected rT3 and put me on pyridoxal-5-phosphate, a water soluble form of B6, which helps convert rT3 to T3 I think. I am also on high doses of iodine, but this is specifically tested. You are gluten free which is important in any autoimmune thyroid, but have you looked at GAPS? I have to 4 cups yoghurt/day, sauerkraut and probiotics, as well as 2 cups/day bone broth, to heal the gut to reduce autoimmune and hyper-inflammation. See if there is a GAPS or Weston Price Foundation practitioner near you.

  15. cc says

    Hi, Thank you for the great info on this website. What would you suspect with normal tsh, t3, t4 and very elevated thyroid peroxidase antibodies and double the normal neutrophils? Thoughts. No infection apparent. Thank You, cc

  16. PDarnell says

    I am soo glad I stumbled upon this site. I kind of thought that I was all alone, mostly due to the fact that most of the doctors I went to just couldnt figure out what was wrong with me and didnt do all the necessary test to try and fiqure out what was wrong with me, I think due to the fact that I got layed off in the middle of all of this and ended up with breast Cancer on top of all of this. I am in remission from the cancer but whatever is happening with my pituitary or thyroid is making me feel like I am 90yrs old. I just cant handle being this way. I am going to try and see if there are any Paleo Physician’s Networks in South Carolina because I want my life back. I feel like I have been robbed of everything.Dont get me wrong,I am thankful to be alive but I just didnt know I was going to feel like I was 90. What can I do till I get to see my doctor and what test should I have him run?

    • Lauren says

      PDarnell – are you doing better now? Any good/bad news to report? I can relate to your situation. It would be great to compare note – thanks.

  17. egle says

    Dear Chris,

    I am really desperate for a constructive advice as I am tired of feeling so tired for the last year. I am 28 years old female. I have been having horrible fatigue for about a year, low blood pressure 90/55, and most of the time experience hypoglycemia episodes(due to this I need to eat every 2 hours to remain my sugar levels), enlarged lymph nodes,always feel cold feet and hands, my morning sugar levels 3.9., my tsh is 0.86, t4is 12. I have been going trough a lot stress for the last 4 years, also 1.5 years ago been working as a Personal trainer with long working hours an not enough rest. I am not working at the moment for 6 months as am too tired even to do the smallest things, I don’t exercise either as i noticed after even light exercise it makes me feel sleepy and the blood pressure drops really low and i feel horrible after, I don’t even go out as after few hours of socializing i feel exhausted and dizzy. Cant handle loud sounds or bright light. Get infections very easy and takes ages to recover.(2 months ago I have been hospitalized for roto virus and toxsoplasmosis and I am still in bed feel horrible plus having joint pain on the top of my ankle/foot) My GP sais that I have chronic fatique sindrome but do not refer me to endocrinologist. In my understanding there could be a problem with my puiritary or/and adrenal gland function which might doesnt let my body to produce enough cortisol. Could it be the case?Please advice as all my life I have been the most active and bubbly person and I cant recognize myself anymore, I really want to find underlying issue and get back to normal life. Thank you again
    Egle

    • Chris Kresser says

      I’m sorry about what you’re going through, Egle. Unfortunately it’s impossible for me to provide medical advice over the internet for complex cases like this. The best I can do is suggest that you find a practitioner that is schooled in functional/integrative medicine. Perhaps try the Institute for Functional Medicine and/or the Paleo Physician’s Network?

    • Lauren says

      Egl – I can relate to your situation. Are you doing better now? Maybe we could compare notes. I can definitely relate to the fatigue issue, that’s for sure! Thanks.

    • Km says

      Egle,
      I can relate. I was exhausted all the time after I had my daughter. I kept losing weight and had no energy despite eating lots and lots of good healthy paleo type foods (esp gluten free and dairy free) and being on Armour-natural thyroid replacement for my hashimotos. My blood work was “normal” at least in reference range for 5 years, but i was losing more and more weight (low 5’8″ 110 lbs from pre-pregnancy of 140lbs) Finally, I found a doctor who examined my body signs and listened to my symptoms. She identified that I was adrenal insufficient and still hypothyroid. She add cortisol to my thyroid, and I also started stress dosing (stop the thyroid madness book), within a day I was off the couch. It has not been a smooth clean ease recovery but I am off the couch still and have more energy. Apparently, cortisol opens the cells up to recieve thyroid. Note, low cortisol (glucocorticoid) correlates with low mineral corticoids (aldosterone -regulates sodium and potassium in blood thus blood pressure) and sex hormones. Cortisol also manages blood sugar and plays a role in food digestion. It has been a crazy ying-yang balancing act to getting it better and still struggling with parts. But I have more energy and was able to return to work after almost a year off.
      As for blood work, my normal reference range did show low normal TSH and T4 with normal T3. One web site says this is a sign of adrenal fatigue -aka low cortisol (aka hormones)
      Thanks Chris for your great posts. I am looking into LDN.

  18. says

    I thought it was just the egg white that is problematic for people with AI? Also, what about ghee? Since it’s mostly fat with almost all milk proteins removed, would it be ok?

  19. says

    Hi Chris,

    You regularly mention inflammation as an issue. I have Adult Onset Stills Disease and take Methotrexate weekly, I feel that I feel that I am suffering from potential Inflamation related symptoms daily (constipation, joint pain, muscle pain, migraine, acne etc), however my ESR is less than 7 and often as low as 2. So I’m wondering whether when you mention inflammation will it always be associated with an elevated ESR. Because my ESR is low, my doc’s tell me that inflamation is normal, however my body tells me something different.

    Steve

  20. Trace says

    Ooh very interesting, I developed thyroid problems after having my third son. I went very skinny (loved this bit) and pigged out…now I’m in the hypo stage. Nothing works, no diets, no low carbing (I just can’t afford the amount of food, apparently I was in starvation mode so stayed fat) but I also have ulcerative colitis and have taken LDN. It’s not helped the weight gain and tiredness but has helped colitis. Levothyroxine hasn’t worked on my thyroid issue either. I’m pretty much stuck.

    • Lauren says

      Trace! I can relate 100% to your situation. I was diagnosed with a thyroiditis three years ago! How are you doing now? Please let me know. I had the thyroiditis where you go hyper and then hypo. Are you doing better? What medicine are you on, if any? I would love to compare our situations! Thanks.

      • rowena says

        Trace, Lauren,

        Please provide your updates on your health.
        I have not been formally diagnosed, but I’ve read a lot, and got my own blood work done at the lab these past few months. I have an appt with my dr on thursday to refer me to an Endocrinologist. My stomach is sensitive to a lot of foods then my face is inflamed with redness. My recent free T3 was low. Thank you for your information.

        Chris,
        Im so happy I stumbled across your website. I think I am on a good path to figuring out my issues. Neither my GI dr, my dermatologist, my general dr, my obgyn, nor any doctor I’ve been to has been able to figure out what is wrong with me.

  21. says

    Thank you for mentioning LDN! You are very brilliant. I was reading an interview with you and Chris Masterjohn recently. I’ve long been a fan of his and Enig, even though I’m a vegan. Long story. Anyway, I didn’t know you recommended LDN at that time. My mother is on LDN for brain cancer, it has saved her life!

  22. Jacquie says

    I just found your website and I am happy for the information you have provided. Thank you.
    The question that keeps running through my mind when I am reading many of the articles is how does all of this relate to someone like me who has had more than just a thyroid disorder but her thyroid removed due to cancer. To prevent the cancer from returning (which it has once already for me), my thyroid meds are high enough to suppress my TSH levels to close to zero. You have mentioned that this effects pituitary function – and I now have a pituitary adenoma that has caused other hormonal imbalances along with PCOS.
    Have you outlined what steps former cancer patients can take to improve how their bodies function when they have their thyroid removed completely? I now know from personal experience how this has cause impaired adrenal function, pituitary function and metabolic syndrome. But since my thyroid hormones need to remain in a certain range to prevent cancer re-occurrence, I am sometimes confused as to whether some of the suggestions I read can apply to my situation. Thanks

  23. Adrienne Baldwin says

    I am 34 years old and have always been in good health until the last year and a half. I have had to children (last being 3 years ago). In the last 3 years, I have fell achy, tired and just old. I began having joint and widening in my hips, hands and feet. I continue to experience it now in a cycle manner. I began working with physical therapists, but it did not get better. I continued to hurt more and become more tired. Then I checked my estrogen and progesterone..both are normal from what test show. Then I check my CBC, prolactin and Thyroid panel. Only my T3 came out low. Everything else was normal. However, I am not sure about the prolactin. I want to know if you think my T3 could be low because my pituitary has a growth causing my joint pain and fatigue and most recently a pain in my temple, jaw and neck. All of the joint pain except for my back are on the Left side. I see an endocrinologist on Tuesday and want to ask him to do specific tests.

    Thank you for your time.

    • kristy says

      Adrienne , you have just summed up all of my symptoms! going to a thyroid speacialist who uses diet and botanical therapy.let you know what I find out.good luck to you!!

  24. says

    Hey Chris,

    Stephan Guyenet has talked a lot about how chronic caloric excess can be an inflammatory trigger. For an overweight client who might be experiencing inflammation due to eating too much, would cutting calories compromise their thyroid function? I’m guessing the answer is only if the caloric decrease is sustained for long periods without refeeds. Any thoughts?

    Thanks,

    -Armi

    • Chris Kresser says

      I don’t think anyone knows the answer to that question for sure, since there are so many variables to consider. My guess is it would vary from person to person.

      • says

        Thanks Chris. Judging by the fact that a host of factors will influence metabolic rate during caloric restriction or caloric surplus, I bet it comes down to the individual. Thanks for responding!

        -Armi

  25. Afifah says

    Dear Chris,
    Thank you for your excellent work in this very difficult field. I wonder if you have any experience with the herb Vitex agnus castus for the autoimmune hypopituitarism. I have a patient currently who could well have this condition, though has not been tested for the anti-bodies (she has obnoxious GPs here in the UK and they give her very very little time or thought) but has been found to be low in cortisol, B12, ferritin and folate, and WBCs. She has had, at 53, extreme stresses in her life so chronic adrenal exhaustion is not surprising. I have now got her gluten free and she doesn’t eat eggs, but is far from well yet. We outed two bowls of gall stones using olive oil and lemon juice, but now I am not sure if they actually came from the gall bladder as ultrasound showed none before they were produced, so I’m not sure where they came from. Her nausea and gut pain, esp at gall bladder area and caecum are quite severe, and she has some blood in her urine and a stone (?) in a salivary gland. I cannot get her onto a high fat diet as it leads to violent gut pain when she tries. She looks hypothyroid but TSH is 1.3. Any thoughts? I feel out of my depth. Thanks in advance

  26. Shelley Goforth says

    Thank you so much for all your research and your efforts to educate us. I am so grateful!

    I have been treated with T3/T4, as well as supplements for adrenal fatigue and bio-identical estrogen and progesterone meds, and my thyroid has not responded as well as my doc liked. He put me on low-dose naltrexone, but within a few days all my happy emotions disappeared (that that I was especially happy before, mind you). What used to feel so good, like getting a head massage with my shampoo at the salon, gave me no pleasure. I stopped it and thankfully, within a week or so things were back to normal.

    I am going to follow your advice and try a paleo diet (I have tried, but failed for lack of menu planning) and see if that eliminates the inflammation my doc says I have. Thanks again for your help!

  27. terry chattsworth says

    how many of you have heard of helminthic therapy? low doses (usually less than 100) of non-infections hookworm, necator americanus, have been studied for several years and often put autoimmune issues like MS, crohns diseast, RA, into remission. they cannot multiply inside you because the eggs need to hatch in soil at tropical temps and humidity, and they therefore cannot infect others. the only catch is once you lose helminths, symptoms usually return, so it is not a “cure”, but they can live for 3-5 years or more, so reinoculating isn’t required very often.

    i have done helminthic therapy and experienced incredibly good results. unfortunately, they were damaged by antibiotic use and i am now hoping to reintroduce them. one unexpected benefit for me was relief of anxiety and depression, since it appears they can calm inflammation in the gut/brain axis, and this has a far-reaching impact. i’m dealing with food intolerances, and hookworm have a reputation for helping about 70% who do the therapy eat a normal diet again.

  28. Clair says

    This is all very interesting. I just curious about reverse T3 and its corollary, free T3 . That’s what my health practitioner seems to be focused on. How might LAH give rise to increased reverse T3?

  29. says

    Great article as usual Chris – you’ve distilled some complex information and made it very accessible.

    Hypopit is also treated with replacement hormones and steroids for the affected glamds. It is not something investigated very often. There are a few folks on the realthyroidhelp.com forum who are hypopit and reading their stories is heartbreaking.

    Starting to think a friend may be autoimmune hypopit – I didn’t realise hyperprolactinemia was a symptom…she is lactacting though she has not had a baby. Also her cholesterol levels are below range and she doesn’t menstruate. Throw in Graves and it seems she may have another autoimmune disease and hypopit may explain all of these factors.

    When will the gluten problem dawn on the orthodox medical profession?

    • Becca says

      Where is the “Like” button? Lol…I also have come across this time and time again in my own research…Thyroid and Adrenal issues linked together and both often linked to gluten or some other toxin.

    • Chris Kresser says

      It’s one possible connection between the two. But in a general sense, any chronic illness or disturbance of homeostasis will tax the adrenals.

  30. Vlad says

    Hi Chris,
    I have disfunctional pituitary (low LH, FSH, TSH), and the reason is an absolute mistery for me, as well as my doc and endro (i have no tumor, trauma, exposure to radiation, etc). But this LAH thing might make sense in my case. Although, i eat and live paleo and don’t realy have any signs of inflamation and otherwise relatively healthy. I guess my question is this: do you think any apparent way to determine if one has LAH other than the elimination diet? Some tests maybe? Thank you

    • Chris Kresser says

      I’m not aware of any commercially available tests. In research settings, they’d test for anti-pituitary antibodies.

  31. Tarri says

    My son, now 31, has been diagnosed with extreme Hyperthyroidism (have fogotten the technical name which affects only 100,000 people mostly of asian descent; my son is not asian) and has experienced Thyrotoxic periodic paralysis in the past. The doctors want to kill part of his thyroid. He HAS NOT gone through that treatment yet.
    He is eating better – high protein diet and has not experienced any paralysis in the last year.
    Is it possible he could outgrow the condition? We are nervous about them killing the thyroid.

    • Becca says

      Tarri, that is part of what happened to me, they removed my thyroid and ablated any remaining tissue. The older I get the worse i feel. Get a good paleo nutritiknist

      • Becca says

        Grr…I was trying to backspace on my phone and it posted it instead. Anyway, get a good Paleo nutritionist such as Chris or another good one is Diane at Balanaced Bites, and a practitioner who isn’t afraid to try other therapies. Graves disease is what your son has, I believe. I had the opposite, but killing the thyroid is killing the thyroid and he will be in the same place I am at in 10-15 years. I HAVE heard of therapies that will reverse almost any thyroid condition. Removing gluten is one of the big ones. I really wish I had had an opportunity to try those things, but I was very young and believed Dr knew best and I did what I was told. If I could roll back the clock 15 years, you better believe I would question everything and they would have taken my thyroid out only after I had tried some other things.

    • Chris Kresser says

      It’s doubtful he will outgrow it, but there are other options for decreasing the immune hyperactivity. I would get him on LDN (low-dose naltrexone) as soon as possible.

  32. Becca says

    Chris, how does one go about finding a Dr who will support the LDN therapy? I talked about it with my DO in Boise and she said she would research it more but wasn’t really very interested. I find that most holistic practitioners aren’t interested in it or don’t know anything about it. Certain symptoms of mine lead me to believe that I would feel 1000x better on the therapy, but I don’t know how to go about finding someone who will rx it. I am moving to Denver in a week, so if you had any resources for finding someone like that, or a colleague in Denver to refer me to, I would so greatly appreciate it!

    • Chris Kresser says

      Join the LDN Yahoo group and post a message asking if there are any doctors working with LDN in Denver. I’m almost certain there will be.

      • Becca says

        Thanks. I have emailed a Dr in Denver, and have also passed this article to a friend who is struggling with many of these symptoms and the Dr’s are unable to find out what is wrong. I hope it helps her to feel better.

      • Becca says

        Thanks, I have emailed a Dr in Denver to see if they still rx it. I am fwd’ing this article to a friend who is struggling with undiagnosable medical problems and I think she really fits the criteria. I hope it will help her.

        One more question, I already eat Paleo, with the addition of some dairy. I can easily cut the dairy and use coconut milk in things for a while, but I have no idea what to eat for breakfast in the place of eggs, if I were to cut those out for a while. I live on eggs for breakfast. Any thoughts?

        • Posy says

          I am interested in breakfast ideas, also. I don’t eat grains, I go back and forth eating limited dairy (I get raw). I can make my own coconut milk but if I give up eggs what then? I was making homemade grain free granola made with soaked nuts & seeds but it has a small amount of honey in it. Looking forward to Chris’s Paleo eating plan as I am so confused about what to eat!

          Posy

          • Chris Kresser says

            Hi Posy,

            Stay tuned next week! The Personal Paleo Code Meal Plan Generator has TONS of breakfast recipes. I know that’s a common question for people, so we focused on it. Plenty of egg-free breakfast options too, and we’ll be adding more each month.

        • Becky Leppard says

          Hi Becca,

          I have been allergic to eggs for a while so have had to find other options for breakfast. The best and easiest is to have leftover dinner for breakfast. I typically will eat veggies and some sort of meat of fish for breakfast. I f you would like some recipes go to EverydayPaleo.com and you will find lots of help. Good luck,
          Becky

          • Becca says

            I have the Everyday Paleo book….I just find a lot of her recipes to be a lot of different ingredients, which is great for dinner, not great when I need to throw something together in the morning quickly. I really rely on eggs a lot. I often incorporate left over meat from the night before into scrambled eggs, I just struggle to eat dinner type food for breakfast, haha. Right now because I feel so poorly (we are moving cross country in 6 days and just shipped out household goods, and so there have been several nights I gave in to the kids request for pizza and now my gut is an absolute mess), I am actually doing something like that…sort of a modified GAPS thing, I made a big pot of stock and added a variety of meats and organic veggies and simmered it all down and am eating that any time I feel hungry. It is soft and digestable and full of nutrients so hopefully will allow my gut to heal up enough that I don’t feel quite so terrible and can get back on steady cooking of paleo foods. I am also going to get some LDN in one way or the other and I think that will help a lot.

        • says

          I can’t do eggs because of autoimmune disease (MS) and it took me about 6 months to truly adjust to no grains and no eggs for breakfast, but now I am totally happy with my breakfasts! In fact, I downright LOVE them because they keep me full, keep my weight under control, and they never trigger symptoms. Typical breakfast foods include: hamburger patty with diced tomato and onion, homemade pork sausage patties, salmon patties, tuna salad, bacon and fruit. It took me a while to adjust, but I am perfectly content with it now. My web site has the recipes for sausage and salmon patties. http://www.fit4godonline.com Good luck!

      • victoria says

        Hi Chris,

        I am 25 years old, i was told 2 years ago that i have thyroiditis, i am on thyroxine 150 a day and for the past 2 years i have battled spending weeks in bed with a swollen neck then i seem to come good and start to feel better then all of a sudden im bed ridden again…the brain fog,heavy body and feeling so tired with no energy is upsetting me so much and im so over it but all the doctors say is all my blood tests show im fine and my levels are good. could this be the autoimmune side of things causing me to feel good one month then horrible the next? its ruining my life

        • Becca says

          They always say the blood tests are fine…they usually aren’t running the right ones, or don’t know how to look beyond the numbers. Have you cut out gluten/grains? I would say that would be a perfect starting point if not. Also, I would have a Dr try you on Armour Thyroid. It has a combination of T3 and T4, and most people do better than on just a T4 replacement. I hope you feel better soon!

          • victoria says

            Thanks Becca,

            Day 2 of gluten free foods. i wish we couldd work out a way to tell our immune system to stop attacking the thyroid…suppressing the immune system is just silly and replacing the thyroid hormone with thyroxine doesnt cure it just helps a little bit. what can we do to stop the immune from attacking the thyroid? get the thyroid removed?

            ox V

        • Chris Kresser says

          Yes, that’s what I’d suspect. You really need to treat the autoimmune condition in this situation. Taking thyroid hormone is often necessary, but not enough.

          • victoria says

            Hi Chris,

            Thankyou so much for replying, im so lost!! how do i treat the auto immune condition because the thyroxine is just not helping my symptoms enough…i used to be fully of energy and fit and fun now im not functioning properly, cant work and just stay in bed and cry…there has to be something i can do? please help? should i get my thyroid removed?

            xo V.

            • Shelley Goforth says

              This may or may not be helpful, but I have noticed that I cannot maintain great thyroid and parathyroid levels, and so function well and feel great, if my estrogen/progesterone/testosterone and adrenals are not also in balance.

              • victoria says

                thanks shelly,

                can i get those tested in a blood test? autoimmune thyroiditis is causing me so many horrible symptoms i will do anything to feel good again.

                xo V

            • Chris Kresser says

              Hi Victoria,

              That’s a complicated question and not at all possible to answer in a comment like this. I’d suggest you find someone to work with to help you with this.

              • victoria says

                ok thanks chris,

                i am seeing a doctor thursday so i will see what she says about getting it removed.. what can i do about my immune system in the mean time?

                thanks!

        • Lauren says

          Victoria! I can relate 100% to your situation. I was diagnosed with a thyroiditis three years ago! How are you doing now? Please respond here, or if possible, e-mail me at readyforwhat7 at yahoo dot com. I would love to compare our situations!

        • Lauren says

          Victoria! I can relate 100% to your situation. I was diagnosed with a thyroiditis three years ago! How are you doing now? Please let me know. Any good advice to share? I would love to compare our situations!

      • Shaun Rusling says

        I am a Male British Gulf War Veteran with (LH) and Hypothyroid which as you know it is very rare in males, Here in my home City Hull East Yorkshire England, Professor Steve Atkin Head of Endocrinology has now diagnosed 29 MALE Gulf War veterans with (LH) I notice you call it (LaH) in the US. I am on GH and Testosterone replacement and Levothyroxine, what T3 supplement would you recommend?

    • Fern says

      Becca, it has been a long time since you posted this, but I am wondering how you are doing now. Did you find help with doctors in Denver?

      I was at the University Hospital UCH in Denver last May and the endocrinologist I saw there recommended the Integrative Medicine department there. I live in Utah, though, so I thought I could try a comparable place at the U of U hospital. In the end, I just looked it up on the internet and thought it was all about nutrition and exercise and that I could do that myself–maybe I am wrong…

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