This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.
In the last post I explained that, for the vast majority of patients, hypothyroidism is an autoimmune disease. This isn’t just an academic distinction. It’s the reason both conventional and alternative treatments are so often ineffective.
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In this post I’m going to show you why taking replacement thyroid hormones without addressing the underlying immune imbalance is doomed to fail.
On the surface it seems like a reasonable approach. Patient doesn’t have enough hormones? Give more hormones. Simple, right?
Not so much.
Once again the conventional approach falls short because it ignores the underlying cause of the problem. It’s like taking Advil when you’ve got a pebble stuck in your shoe. It might work for a little while, and might even be necessary to dull the pain. But you’d be a lot better off if you took the pebble out of your shoe. Right?
Let’s take a closer look at why thyroid hormones often don’t work, or stop working over time. The following diagram illustrates how autoimmunity affects thyroid metabolism (please note, “HPT” stands for “hypothalamus-pituitary-thyroid axis”):
Immune dysregulation is another term for autoimmune disease. We still don’t know exactly what causes it, but most researchers agree it’s a mixture of genetic susceptibility and environmental factors such as iodine (excess), infection, pregnancy, diet and intestinal permeability.
In autoimmune disease the body attacks itself. It does this the same way it attacks foreign invaders like bacteria and viruses: with T-cells, B-cells, natural killer cells, and cytotoxic T cells. The immune response also involves proteins called cytokines, chemical messengers that pass messages between cells.
This self-attack by the immune system increases inflammation. And inflammation has a profound effect on all aspects of thyroid metabolism and physiology.
First, inflammation suppresses the HPT axis. (1) One study showed a single injection of the inflammatory cytokine TNF-alpha reduced blood levels of TSH, T3, free T4, free T3 and TRH for 5 days. (2) This shows inflammation disrupts the production and regulatory mechanisms of thyroid hormones. Thyroid medication will increase the levels of T4 (and possibly T3), but it doesn’t address the other effects of HPT axis suppression.
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Second, inflammation decreases both the number and sensitivity of thyroid hormone receptors. (3) If there aren’t enough receptors, or they aren’t sensitive enough, it doesn’t matter how much thyroid medication we take. The cells won’t be able to use it. It’s like when my grandpa used to turn down his hearing aids while he was watching the football game. It didn’t matter how much my grandma yelled at him – he couldn’t hear a word she said.
Third, inflammation decreases the conversion of T4 to T3. (4) T4 is the inactive form of thyroid hormone. The body has to convert it to the active T3 form before it can be used. Most synthetic hormone medications on the market are T4. If you give a T4 medication (like Synthroid, Levoxyl, Unithroid, etc.) to someone with inflammation, it’s not going to work because they can’t convert the T4 to T3.
Patients who don’t convert T4 to T3 well do better on bio-identical hormones like Armour, because it contains both T4 and T3 (in a 4.22:1 ratio).
Inflammation disrupts thyroid metabolism in several other ways, but I think these three examples make the point.
Now let’s review.
The only way to do that is to address the problem at its root by regulating the immune system and decreasing inflammation. (For more on how to address underlying inflammation, check out this episode of Revolution Health Radio with Izabella Wentz.) Unfortunately, this is rarely done in either conventional or alternative treatment of thyroid disorders.
Before I sign off, I just want to make one thing clear. I’m not saying thyroid medication isn’t necessary or useful. In fact, I think it’s an important part of treating Hashimoto’s—especially when TSH is consistently elevated and T4 and T3 are consistently low. My point is thyroid medication is only one piece of the puzzle, and it won’t be effective on its own unless the autoimmunity and inflammation are addressed.
If thyroid medication is the fantasy magic bullet of conventional medicine, iodine is the equivalent in alternative medicine. In the next post I’m going to explain why supplemental iodine may cause more harm than good in Hashimoto’s patients.
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I thought this article was highly informative! I was recently diagnosed with sjogrens disease and placed on plaquenil. I feel slightly better. My neuro opthomologist told me i have thyroid disease, but my thyroid tests are never abnormal. i have almost all the symptoms of hypothyroidism and do not feel very good. my question after reading your article is could my t4 be bad and not doing what its supposed to be doing to get t3 to work? My hypothyroid symptoms have been with me since my late 20’s, and my regular doctor always thought i had it to. I would love to hear your feedback and any recommendations would be appreciated. Thanks very much, Susan
loved the article. my rheumatologist says i have sjogrens disease and my neuro eye doctor says i have thyroid disease. I have so many symptoms of underactive thyroid, but my blood test are in the “normal range”. No doctor will even test me on a low dose thyroid medication. My question is can my thyroid be producing hormones that don’t work in my body and if thats the case how do i treat it? I take Plaquenil and feel very slightly better, and my dr was surprised. I really think there is an underlying 2nd auto immune disease that is being missed. i think it is in fact my thyroid. I would love to here your thoughts. Thank you!
I have had hypothyroidism for at least 7 or 8 years, and was diagnosed with fibromyalgia 5 years ago. Although I have been taking levoxythyroine from my doctor, I recently looked at a list of hypothyroidism symptoms – fatigue, joint aches, weight gain, constipation, dry skin, sexual problems, hearing difficulties, hoarseness, memory and concentration problems, intolerance to cold, and slow body movements….I have them all! So my question is, it is known that fibromyalgia causes inflammation. It is possible all these years my thyroid medication has not been working, despite that my doctor looking at medical tests thinks it was working? Also, what suggestions would you have or articles could you point me to? Thank you.
I have been hypothyroid since my last child was born in 1987. I was on Levoxyl for years at 137 mcg. About 3 years ago I started to feel like my thyroid was not functioning properly. Thyroid panel depicted all was fine. I asked why do I not feel fine? Within 3 days of doctor increasing thyroid meds to 150 mcg in March of 2012 I developed vitiligo on my hands and feet, which now has spread to my legs and face. I have gained almost 40 pounds and have lost about half of my hair. In April of 2012 doctor reduced thyroid meds back to 137 mcg. I have been going to another doctor, who is a endo, and he has done several test and tells me he thinks I have poly glandular along with hashimoto. He determined this from a ultrasound done on my thyroid that is half their size. He put me on 112 mcg of synthroid and 3 tabs of cytomel at .5mcg. I started feeling like I was on a merry go round. Feeling dizzy and light headed. Realized it was the cytomel. Since I stopped the cytomel dizziness had subsided. And now I am back on the synthroid of 137 mcg. My question is, why am I still suffering from thyroid symptoms and they are telling me my numbers are fine?
I am on armour thyroid. I started out with 60 mg and increased to 120 mg through my natural doctor. I am having horrible insomnia, cold, constipation, tired, temps are 97.0 and heart rate is 68. It seems like this armour is not working or raising my t3’s and t4’s. My t3 has stayed the same. Any tips?
Sounds like you have Adrenal fatigue.
What are the effects on your body/health of Hashimoto’s after TT (due to cancer)? Are there still antibodies? Do they effect other parts of the body or do they still cause hypo symptoms?
I have Hashimoto’s and became toxic on levothyroxine, suffering horrible internal shakes and tremors which in turn, caused horrible weakness. I stopped taking the levo, got better after 8 days. Stayed off for 5 weeks, but my TSH went to 138. I had to try Armour. Been on 15 -45 g of Armour now for 3 months. My TSH is down to 8. But the tremors are back. Just like when I was on levothyroxine with a 0.5 level. The tremors are horrible. Feels like a tousand bees buzzing around inside of my body. The vibrations (tremors) have a megahurtz. They can be constant or come in constant waves. They are terrifying and impossible to live with. So I find myself quitting the Hormone replacements, which I should not do, but I can’t take the tremors, nor can I take a high TSH level and all the syymptoms associated with that. What can I do when I need the medication for Hashimoto’s but cannot tolerate any of it? Please help.
Dianne
diane , have you had your adrenal glands checked. I would also get a complete thyroid panel done.
Dianne,have you found a solution to your problem,as I have exactly the same things going on
I had the same problem in my case it is caused by low adrenals.I take Adrenal Formula Dr. Christopher’s 2x a day and Ashwagnada at night 500 mg. It works like magic no more Inner trembling.Feel better.
“The only way to do that is to address the problem at its root by regulating the immune system and decreasing inflammation. Unfortunately, this is rarely done in either conventional or alternative treatment of thyroid disorders.”
How do you do this ? I could totally see this being my issue.
Greetings Chris!
I have had hypothyroidism for a few years and been taking a low dose of synthroid. When I got pregnant this year they kept increasing my dosage (I also got diagnosed with gestational diabetes and preeclampsia). I gained a whopping 100 pounds in a matter of seven months. Once I had the baby they said that my levels changed and they kept lowering my dose. All of a sudden they said my levels were too high bordering hyperthyroidism and recommended that I completely get off my medicine. They tested my levels again and all of a sudden my panel says I am normal. I am losing my hair in clumps, gained 15 pounds in two weeks, have dry skin, etc.. It’s been four months since I had my son and I haven’t a clue what’s causing all this. How can I suddenly be normal when frankly, I feel crazy. I can get more specific data, but until then I just appreciate the fact that you respond to comments and want to thank you for your time!
Dear Chris,
I live in Canada and around 3 years ago I was diagnosed with hypothyroidism (an endocrinologist prescribed Synthroid). I have an adenoma in my pituitary gland. I have been taking 0.05mg of synthroid since the diagnosis. From the past 5 months I have been experiencing lots of symptoms, I feel like a dead woman walking (I am 39 years old).
I also started reading the book “Stop that Thyroid Madness” (Do you know it?, if yes, can you briefly comment on it?). Through this book I have learned a lot about my condition and Drs/the system’s mentality. I am scared but hopeful that I will have in the near future a better treatment and life. I am considering Armour.
My endocrinologist found (last time I had an appointment 2 months ago) that my THS levels were high so he increased the synthroid from 0.05mg to 0.1 mg. And is not helping, I am not close to doing well.
My last lab test (yesterday) showed that my levels (with the increased dosage) are at 1.1 mU/L in a 0.27-4.2 range
I am going to take a saliva test to check my adrenals for adrenal fatigue.
I know that I have very low ferritin (I requested the test to my GP).
So, even though I still have to learn a lot about all this I think I am walking down the right path. What do you think?. Please, comment, it is very difficult to trust the system and the Canadian one is very conservative plus there is no Private system.
All the best for you!
Cheers!
Diana
Dear Diana, Did you ever get your health issues resolved. My husband had a pituitary adenoma that was pressing on the optic nerve. The adenoma was removed but the pituitary gland damaged in the process. He then went to a different doctor (Thank God)- a pituitary clinic in Rochester NY at Strong Hospital. He was put on thyroid, growth hormone, testosterone, and then cortisol by doctors who titrate the meds and apparently know what they are doing. At 67 he feels great.
Hi, My TSH level is .0001 and my T4 is normal. My doctor won’t test T3, until affordable care act takes effect this is all I can do. I have Hashimoto’s disease and have half of my thyroid removed. My doctor has lowered my levithroid from .125 to .100. I know this is a bad idea, but I don’t know why or what’s going on.She won’t give me Armour or T3. My gut feeling is I’m not converting to T3 and my TSH is trying harder, which probably just shows what I don’t understand. But I have had this for 10 years that I know of, I don’t think I’m suddenly have a more productive thyroid. Help!
i TAKE Synthroid and have nodule on thyroid. 137 not enough and causes blood pressure to go up and 150 too much, causes stomach to swell and very uncomfortable. I do not know what to do. My doctor does not know what to do., Should I have biopsy done on nodule to see if cancerous? Please help
Hi Chris! I was diagnosed with hypothyroidism 5 years ago. I immediately went on synthetic compounded t3/t4 and it worked! At one point I went to a clinic to treat some underlying gut issues and food allergies etc and this alternative doctor was convinced that I did not need my medication. I went off it for a month and immediately gained weight! I went back on and it took about 2-3 months to lose my weight again.
Fast forward to another recent situation where a new doctor had the same theory, that my body did not need thyroid medication because my TSH was SO low even though my t3/t4 was normal. I went off it for a month and again gained 10/11 pounds in 4 weeks. I am back on a new thyroid (taking armour now) and its been about 6 weeks. I have not lost my weight yet, but my t4/t3 are normal/high normal.
My question is does it take a longer time to really kick into the body? Or could it be that I am not on the right medication since I was on synthetic compounded before vs. my new dose of armour. Thank you!
I have been taking thyroid meds for abt 11 yrs now. I was diagnosed with hypothyroid after the birth of my 2nd son. At 1st they seemed to work, but the effects quickly wore off. My dr recently decreased my levothyroxine and added liothyronine sod. I felt even more fatigued than before so I stopped taking the new drug. I know I should consult my dr, but I am tired of going round and round with no real results. Your thoughts?? Also, I was recently diagnosed with an immobile esophagus. I’m not sure what, if anything, that adds to the equation. Any input would be appreciated. I am way too young to feel this tired all of the time. It is very frustrating, and effecting my daily life.
Hi. I am worried as I have been taking thyroid for 3 and a half years and my medication handle gone from 50mg to 200mg but my tyrosine is getting worse. The medication is making me get headaches and my levels went from 8 to 32 and is now 49 even with regular medication and upgraded medication. Someone told me that they had a tumor on their pituatry gland and it caused the same thing. Doctors and specialists are baffled and at only 17 years old and gaining weight rapidly which is affecting my life (even eating nothing but fruit makes me gain weight). Absolutely terrified now as no one knows and this woman told me about her tumor and not sure what’s going on….
Hi there.. About 24 years ago I came down with Hyperthyroidism,/Graves Disease both sides of my thyroid gland had pretty much grown up both sides of my neck. I was treated with radioactive Iodine, and was put on a perpetual Synthroid mix. Now Is leaky gut syndrome also the cause of my original Hyperthyriodism? What can you reccomend for me as a Hyper—> Hypo patient?
Thank you Renee
I have Hoshimotos and Im worried about getting pregnant,does it affect the fetus in any way???
I was wondering what the percentage is of people with Hashimoto’s needing to have their thyroid removed?
After years and years of the antibodies produced attacking the thyroid, even with treatment, wouldn’t the thyroid gland be killed off? Also, if having Hashimoto’s means you have to be on hormone replacement for the rest of your life anyway, wouldn’t it just be easier to remove the thyroid and be on the hormone replacement so your body doesn’t produce those antibodies? I don’t assume having those antibodies being produced in your body is very good for the rest of your organs?
And one more question. I have severe night sweats and my doctors can’t tell me why. I really have no idea if it could be my thyroid causing them. I know that Hashi symptoms can continue even while being treated, but I don’ t know if any of the symptoms I have are caused by my thyroid or some other unknown problem. I don’t think that my results have ever shown that I go hyper as well as hypo, I don’t know if that happens to me or not (before taking Levo or during). As far as I’ve read, night sweats are a symptom of hyper and not hypo. But, could my thyroid being causing night sweats even if I am just hypo and being treated with Levo?
Neeters – I’m a 45 yr old woman who has SERIOUS fatigue (nearly bedridden at its worst) et al issues for 4 years. All the Western med tests were “normal.” What brought me back first was progesterone and Ashwaghanda herb (for adrenal). Then, a Naturopath put me on herbs to balance out my hormones/endoc system and it started working in 3 days. More energy, sleeping without insomnia for first time in those years. Especially since you are in menopause years, I highly recommend looking into herbs. They SAVED my life and are EXTREMELY effective. Western med hasn’t a clue – or pharma comp’s just want it this way. Good luck!
I agree with you chris that the underlying medical issues must be discovered and then addressed. However, for some of us, especially women after Menopause, and in my case specifically, we tried everything, for two agonizing years. tests were normal. GP wouldn’t treat, or even test further than TSH. meanwhile, TSH kept climbing, every 6 months, by at least 1 point. I removed Gluten and grains. increased iron stores and vit. D3, stopped exercising due to exhaustion.. took BHRT (Progesterone, Bi est and Testosterone.) taking all appropriate supplements to help t4/t3 conversion.
Was treated for Adrenal dysfunction (I believe caused by untreated hypothyroidism). Became so sick and tired and cold, gained 40 lbs in 5 months, had to leave work, accepted for total disability at age 52.
In the end, the doctor agreed to finally let me try a trial of Natural Dessicated Thyroid. BINGO.
back to normal in a few weeks. going back to work and enjoying life again.
Lesson learned? sometimes, thyroid output , whether considered normal by conventional medicine, is not enough for quality of life. Hormone supplementation Is Sometimes Required.
In my case, I suspected thyroid all along and nobody would listen.