Category: Thyroid | Page 31 | Dr. Westin Childs: Thyroid Supplements & Thyroid Resources
Low TSH Symptoms 5 Important Causes + Your Next Steps

Low TSH Symptoms: 5 Important Causes + Your Next Steps

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Evidence-Based

Have you been told that you have a low TSH? Are you experiencing symptoms such as It may surprise you to know that a low TSH can be associated with multiple conditions all of which present in different ways.  This article will go into detail on how to interpret your TSH, how to determine the …

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Thyroid Deiodinase How D1, D2 & D3 Enzymes Alter Your Thyroid

Thyroid Deiodinase: How D1, D2 & D3 Enzymes Alter Your Thyroid

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Evidence-Based

Thyroid deiodinase enzymes serve to manage thyroid hormones at every level of metabolism.  Even more important is the fact that these enzymes can become dysregulated by everyday common medical conditions.  Understanding the importance of these enzymes is critical to understanding how to further treatment, especially if you are taking thyroid medication such as levothyroxine or …

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subclinical hyperthyroidism guide: natural treatments and more

Subclinical Hyperthyroidism Guide: Natural Treatments, Symptoms & More

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Evidence-Based

Subclinical hyperthyroidism is a potentially serious thyroid problem that can go undiagnosed if you aren’t looking for it.  This condition can also be confused with other medical conditions which means that not everyone with this disease should undergo treatment.  Learn more about this condition including what causes it, how it presents (symptoms), conventional treatment as …

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TRH and TSH How they Impact Thyroid Function & More

TRH and TSH: How they Impact Thyroid Function & More

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Evidence-Based

TRH is an important hormone produced by your brain which regulates thyroid function in your body.  But most doctors aren’t ordering this important lab test! In addition, certain problems can result in reduced levels of TRH which may manifest as hypothyroid symptoms.  Learn more about TRH including what it does, how it works, what causes …

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understanding and interpreting the thyroid stimulating immunoglobulin thyroid lab test

Thyroid Stimulating Immunoglobulin (TSI): What High Levels Mean

What does thyroid stimulating immunoglobulin mean? Do your results correlate with the severity of your hyperthyroidism? Is there a way to lower your antibody levels? You probably already know that the presence of these antibodies may be an early warning sign that your body is suffering from an autoimmune disease, but what are you supposed …

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Thyroid storm vs Thyrotoxicosis: Symptoms, treatment and more

Thyroid Storm vs Thyrotoxicosis: Dangerous Thyroid Conditions to Be Aware of

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Evidence-Based

What exactly is thyroid storm? How dangerous is this condition and how will you know if you have it? This post will concentrate on this medical condition and teach you everything you need to know about it.  Including the difference between regular hyperthyroidism and thyroid storm, the difference in symptoms, how to prevent it from …

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Subacute Thyroiditis Guide Recovery Time, Treatment, Diagnosis & More

Subacute Thyroiditis Guide: Recovery Time, Treatment, Diagnosis & More

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Evidence-Based

Subacute thyroiditis is not the most common cause of thyroid related-issues, but it’s still important nonetheless.  This condition may result in pain in your thyroid gland and can be confused with other disorders such as Hashimoto’s thyroiditis and Graves’ disease.  Learn how to diagnose this condition, how long it takes to recover, and natural treatment …

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Can medications cause thyroid problems

Can Medications Cause Thyroid Problems? Supplements & Medications to Avoid

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Evidence-Based

Do you have thyroid problems? Are you taking thyroid medication? Are you also taking other medications? It may surprise you to know that there is a long list of medications that can alter thyroid function, interfere with thyroid tests or even interfere with your thyroid medication.  This post will teach you about these medications, what …

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Is it safe to exercise when you have thyroid problems_

Is it Safe to Exercise When you have Thyroid Problems?

Is it dangerous to exercise if you have thyroid disease?

How much is “too much” exercise?

Will exercise help you lose weight or will it hurt your metabolism?

All of these questions and more will be answered in this post which is all about exercise and thyroid problems. 

You will learn the best types of exercises, how much you should be exercising, and the best way to lose weight

Let’s jump in: 

Understanding Metabolism, Exercise, and Caloric Burn

We really can’t have a discussion about exercise without at least touching on the idea of metabolism. 

The term metabolism is often used when referring to the number of calories that your body burns throughout the day. 

It’s also commonly referred to as resting energy expenditure (REE) and resting metabolic rate (RMR) (1).

And it is your metabolism that accounts for the largest number of calories that you burn each and every day (not how much you exercise!). 

Your metabolism is responsible for around 50 to 90% of the total amount of calories that you burn (2) each day. 

Your body uses this much energy because it must keep you alive by beating your heart, helping you think, helping to digest your food, and so on. 

These things MUST happen every single day and they are very energy intensive (meaning it requires a lot of energy). 

So if around 70% (I’m taking an average between 50 and 90% here) of the calories you burn each day is from your metabolism, what accounts for the other 30%?

That other 30% really depends on your activity level and it can change from day to day (3) (which alters your appetite!). 

Activities such as stress, extra walking, going shopping, doing chores around the house and so on all require more energy, and these factors account for the other 30%. 

It may be helpful to look at a 2,000-calorie-per-day example to drive this information home. 

Let’s assume that you burn 2,000 calories per day (on average). 

Using the figures above we know that about 70% of the calories that you burn each day will be from your metabolism. 

This accounts for around 1,400 calories per day. 

Around 50-60% of your metabolism is controlled by your thyroid (4)!

Just keep this information in the back of your head, we will come back to it later. 

The remaining 30% of the calories that you burn comes from other sources and your activity level which accounts for 600 calories per day. 

So, when most people want to lose weight they think they can burn more calories simply by increasing the amount that they exercise (5).

But let’s consider another example here. 

What if your thyroid is sub-optimal and you aren’t being treated appropriately?

If your thyroid is responsible for around 50% of your metabolism and your thyroid is not functioning well that means you may be losing out on an extra 400 calories per day from a damaged metabolism!

It may be far easier to simply address your thyroid problem to help increase the number of calories you burn by an extra 400 per day because trying to burn an extra 400 calories per day would take a significant amount of time through exercise

Does that mean you should avoid exercise?

Not by a long shot!

But it does mean you may want to ensure that your thyroid is working properly before you jump into serious workout routines. 

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Should you Exercise if you have Thyroid Issues?

It may sound like I’m discounting the benefit of exercise and I don’t want that to be the case. 

Exercise is critical to living a long and healthy life (6).

It’s also incredibly helpful if you have thyroid disease and can help manage your hormones. 

So the answer to the question as to whether or not you should exercise is a definite YES. 

But what you need to understand is the amount and type of exercise that you use will vary from individual to individual

It also means that there isn’t one single “best” exercise routine that you HAVE to do. 

Exercising is beneficial to your body (and your thyroid) because it can help improve your metabolism

It does this by increasing the activity and size of your muscles. 

And it takes a considerable amount of calories to keep your muscles happy and active (7).

Increasing muscle mass will help you improve the overall amount of calories that you burn in that 70% portion. 

In addition, exercising also has the benefit of increasing the number of calories that you burn day to day. 

This will help increase the number of calories that you burn in the 30% portion. 

Another point worth mentioning has to do with your goal when you exercise.

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If you are like most people you probably only consider exercising as a means to manage your weight.

And this is the wrong way to look at it. 

You want to exercise because it will help your body manage your hormones, manage the flow of calories, and which tissues utilize those calories as a way to improve your muscle mass

Many of these things may help with weight loss, but that shouldn’t be your goal! 

As you exercise more and more, you may notice that your muscle mass increases accordingly. 

This increase in muscle mass is often associated with a decrease in fat mass (this is a good thing) but it may keep your weight “neutral” or the same. 

And this is NOT a bad thing. 

Your goal when losing weight should be to lose fat mass, and that’s exactly what exercise will do. 

Exercise and the Stress it Causes to Your Body (And your Adrenals)

One of the questions I get asked from people on this blog has to do with adrenal function and exercise. 

Many patients with hypothyroidism also happen to suffer from the symptoms associated with “adrenal fatigue” and many of these patients also have abnormal or sub-optimal serum cortisol levels

If you fall into this category is it still safe to exercise?

You have to consider that exercise is a stressful event for your body (8).

The whole goal of exercising is to break down the body slightly while allowing it enough time to heal so it grows back stronger than it was before. 

When you keep this in mind it’s easy to understand that true exercise is not something that you want to do every single day. 

If you do not allow your body sufficient time to heal then your exercise may just be adding more and more stress to your body (this is a bad thing!). 

This element of stress can compound other sources of stress such as lack of sleep, a poor diet, social stressors, and more. 

The net result?

More stress to your body and the worsening of your symptoms such as fatigue, weight gain, crashes in the midday, and more

This means, contrary to popular belief, that doing spin classes for 1 hour each day may not be the best way for you to lose weight and feel better!

So what are you supposed to do? 

You should aim to match the intensity of your exercise routine to your personalized energy level. 

By matching the intensity of your workouts to your energy level you can stay within the “optimal” range of exercise without risking damage to other hormones. 

As you match your intensity to your energy level you will find that your energy level IMPROVES, your fatigue REDUCES and you start to feel better overall. 

I will go over how to match this in a bit but first I want to focus on the types of exercises that you can (and should) be doing. 

Is there a “Best” Type of Exercise if you have Thyroid Problems?

There isn’t a single “best” type of exercise for your thyroid. 

There also isn’t an exercise that will improve your thyroid function!

But, there are several types of exercises that would be considered “approved” and helpful if you have a thyroid problem. 

In general, you want to look at two basic types of exercises:

#1. High-intensity interval training.

Exercises that fit into this category include:

  • Circuit training (body weight)
  • Circuit training (9) (weight training with resistance)
  • Cycling
  • Strength training
  • Virtually any exercise can provide this benefit if taken to the extreme

#2. And low-intensity exercise.

Exercises that fit into this category include:

  • Yoga
  • Pilates
  • Walking
  • Swimming
  • Household chores

How Often Should you Exercise? 

Most people probably know the various types of exercises available to them, but they struggle when it comes to frequency. 

Meaning, how often should you be exercising?

How often should you do high-intensity interval training and/or low-intensity training?

The answer is actually quite simple:

You’ll know if you are exercising at a sufficient rate if you feel energized after you exercise

Exercising should lift you up, it should increase your energy, and should make you feel good. 

If you are exercising and you find that you are wiped out for several days afterward then that is a sign that you are over-exercising! 

You will want to avoid this behavior as much as possible because it can lead to more metabolic damage in the long run. 

If you are new to thyroid-related issues and you want to get started then the goal should be to start low and slow. 

Starting with high-intensity exercise for 15 minutes 1-2x per week is usually a safe bet

As you progress, and as you listen to your body, you can increase both the duration and frequency with which you exercise. 

Something like 15-20 minutes of high-intensity interval training 2-3x per week usually works very well for most people

This can be supplemented with daily low-intensity activities. 

As you determine which exercises you should be doing it’s worth pointing out that you should put preference on those types of exercises that help to build muscle mass in your body. 

The more muscle mass you have the higher your metabolism will be. 

You can do this by focusing on the major muscle groups in your body:

  • Chest
  • Legs
  • Back
  • Shoulders/arms

Focusing on these muscle groups will give you the biggest “bang for your buck” so to speak. 

If you focus on weight training just make sure that you do not exercise muscle groups that are already sore from previous exercise regimens. 

Adding Intermittent Fasting & Sauna to Your Exercise Routine 

Lastly, you can also supplement your exercise routine with a couple of other therapies which have the capacity to enhance your results. 

It may be tempting to take pre-workout boosters, thermogenics,s or caffeine-laced supplements but do your best to avoid these supplements if you have thyroid issues

They can actually make your fatigue worse in the long run by putting excess stress on your body as you exercise. 

As you avoid these therapies you can also consider adding some others. 

Specifically sauna therapy and/or intermittent fasting

You can add sauna therapy to the end of your workout session which will act to increase your body temperature (10), help you sweat and detox and improve circulation (11) to your muscles. 

Intermittent fasting will help you burn more calories and impact your hormones (especially insulin and leptin) if combined with exercise (particularly HIIT). 

As always, proceed with caution if you have never tried these therapies before. 

They certainly have the ability to improve your results but they also may cause side effects if you aren’t sure how much your body can manage. 

Conclusion

Exercising with thyroid issues is an important and complex topic!

Exercising can help benefit your body, help with your weight, manage your metabolism, and more. 

But in order to get these benefits, your exercise routine must be targeted to your body. 

You can do this by listening to your body. 

If you aren’t sure where to start you may find benefit in looking for a functionally minded health coach to help guide you along the way. 

Now I want to hear from you:

Are you struggling with exercise as a thyroid patient?

Have you been able to realize any benefits from your workout routine?

What workouts have helped you? Which have not?

Leave your comments or questions below! 

#1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424457/

#2. https://www.ncbi.nlm.nih.gov/books/NBK218769/

#3. https://www.ncbi.nlm.nih.gov/pubmed/21178922

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4044302/

#5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639963/

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395188/

#7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661116/

#8. https://www.ncbi.nlm.nih.gov/pubmed/18787373

#9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562558/

#10. https://www.ncbi.nlm.nih.gov/pubmed/3218894

#11. https://www.ncbi.nlm.nih.gov/pubmed/1837250

the best exercises for thyroid problems
What Causes Thyroid Disease: 14 Common Reasons Listed

What Causes Thyroid Disease? 14 Common Reasons Listed

It is estimated that up to 10% of people have a thyroid problem (1).

But what is causing thyroid disease in all of these people?

It turns out that there are many causes of both reversible thyroid disease and irreversible thyroid disease. 

But which type do you have?

In this post you will learn the most common causes of thyroid disease, how to spot problems that may impact thyroid function in your body, and what to do about these problems

What Does it Matter What Causes Thyroid Disease?

The main reason you should be interested in the cause of your thyroid disease is that it can help you target your treatment!

And, it may surprise you to know, that most physicians are not concerned about the cause of your disease. 

Doctors are trained to find the name of diseases, but they don’t always look for the root cause of those disease states. 

It may be depressing to hear this, but there’s really no other way when a Doctor only gets to spend on average somewhere around 15 minutes with each patient with only around 5 minutes on each “topic” or problem (2).

5 minutes is not a sufficient amount of time to find the cause of a disease, so it’s much faster to “name” a disease and then treat it with medication. 

But this approach is not ideal, especially if your condition can be reversed! 

For these reasons, it’s important for you to have a basic understanding of your thyroid so that you can learn what is happening in your body and attempt to fix or reverse that issue. 

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Foods to Avoid if you Have Thyroid Problems:

I’ve found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should avoid if you have thyroid disease of any type.

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The Complete List of Thyroid Lab tests:

The list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose and manage thyroid disease correctly!

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Thyroid Dysfunction vs Hypothyroidism

When we discuss the causes of thyroid disease we really need to differentiate between two important conditions: thyroid dysfunction and hypothyroidism. 

Thyroid dysfunction is a condition that results in disordered thyroid hormone signaling (3).

This means that you can still create thyroid hormone but the hormone that you create isn’t working as intended by your cells or by your body. 

Thyroid dysfunction is often a result of some other condition and can usually be reversed!

Hypothyroidism, on the other hand, is a condition that results in a DECREASE in the amount of thyroid hormone that your body produces. 

Those with hypothyroidism usually have problems with their thyroid gland itself, or with their pituitary/hypothalamus, and their thyroid disease is their primary problem. 

Hypothyroidism may or may not be reversible so it’s very important to distinguish between thyroid dysfunction and hypothyroidism if you are experiencing hypothyroid symptoms. 

These conditions can often be confusing because they may both present with similar symptoms and with similar thyroid lab tests. 

But, with the right information, you can easily distinguish between these entities. 

Causes of Thyroid Dysfunction

#1. Obesity

Obesity may be one of the most “silent” causes of thyroid dysfunction out there today. 

If you are overweight by even as few as 10 pounds you may have some element of thyroid dysfunction. 

Emerging research and studies have shown that obesity may be a CAUSE of thyroid dysfunction, not the other way around and this is why it’s so important. 

If you are overweight you may be causing damage to your thyroid which will make weight loss more difficult until you treat that problem. 

People who are overweight often have lower than normal free T3 levels compared to healthy adults (4) and you can check for this with a simple blood test. 

#2. Calorie restriction or Dieting

Calorie restriction of as few as 1,500 calories per day can cause long-term damage to your metabolism through your thyroid. 

As you restrict your calories your body will respond by reducing free T3 and by increasing reverse T3 (5).

This signals to the body that you are burning too many calories compared to what you are eating and this is how the body responds to stop that process. 

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This process is also referred to as starvation mode and it is probably the main reason why people gain weight after they undergo a diet. 

If you are doing this make sure you STOP, even if it means temporarily gaining some weight. 

#3. Nutrient Deficiencies

There are more than 10+ vitamins and minerals that are required for proper thyroid hormone creation and conversion. 

As people become more reliant upon unhealthy snack foods found in the Standard American Diet, it’s not uncommon for people to have many sub-optimal nutrient levels. 

These minor deficiencies typically do not cause a tremendous problem but they can definitely make you feel run down or sluggish and prevent you from feeling at 100%. 

Some of these nutrients, especially Zinc and Selenium, are involved in the T4 to T3 conversion process with your thyroid. 

Taking certain supplements can help replete these levels in your body and may help you feel much better!

#4. Insulin & Leptin Resistance

Both insulin and leptin resistance, which are quite common, have been shown to interfere with thyroid hormone signaling (6).

Both of these conditions can lead to weight loss resistance (the inability to lose weight) which can further complicate thyroid function. 

If you have thyroid disease AND you have either of these conditions then you can focus on treating these which may improve your thyroid. 

#5. Chronic Illness and Chronic Infections

Chronic illness refers to medical conditions that are with you for life and conditions that often require the use of medications to treat them. 

Conditions such as high blood pressure, cardiac disease, high cholesterol, chronic pain, fibromyalgia, and so on all result in stress to the body. 

Small stressors day in and day out may result in thyroid dysfunction (7) which you may feel as fatigue, weight gain, or depression. 

In addition, these medications often also require the use of medications which is #6 below. 

#6. Prescription Medications

It is well known that many commonly prescribed medications may cause problems with thyroid function at all levels (8).

Medications can interfere with thyroid hormone creation, TSH production, and thyroid conversion. 

And the medications which cause these problems are actually used by many patients!

Medications that fit into this category include:

  • Beta-blockers and other medications for high blood pressure
  • Diabetic medications and medications that control blood sugar
  • Anti-seizure medications
  • Narcotics and pain medications
  • Antidepressants and bipolar medications
#7. Inflammation

Lastly, any cause of inflammation in your body will also result in decreased thyroid function. 

This is because inflammation slows down the T4 to T3 conversion process (9) and results in smaller amounts of free circulating active thyroid hormone. 

Inflammation is really a non-specific entity but, in hypothyroid patients, this type of condition is most often caused by intestinal-related issues such as gut dysfunction and intestinal overgrowth syndromes. 

Causes of Hypothyroidism

#1. Hashimoto’s Thyroiditis

Perhaps the most common cause of hypothyroidism in the United States is the autoimmune disease known as Hashimoto’s thyroiditis

This condition, if untreated, results in complete destruction of your thyroid gland over a long period of time. 

As your thyroid gland is slowly destroyed your ability to produce thyroid hormone is compromised and you will begin to experience the symptoms of hypothyroidism. 

It is estimated that anywhere from 50-90% of patients with hypothyroidism may have Hashimoto’s to blame for their disease. 

#2. Thyroiditis

While Hashimoto’s thyroiditis is a cause of thyroiditis it is certainly not the only cause. 

Thyroiditis simply refers to inflammation of your thyroid gland and this can be caused by other conditions such as infection or trauma. 

Any inflammation in your thyroid gland may reduce the function of the gland in the process which will leave you feeling symptomatic. 

These conditions are often easy to diagnose as long as you understand them and you can learn more about them here.

#3. Treatment for Hyperthyroidism (Thyroidectomy and RAI)

Would it surprise you to know that another very common cause of hypothyroidism is the treatment of hyperthyroidism?

Hyperthyroidism is the exact opposite condition of hypothyroidism but the treatment often entails either the complete removal of the thyroid gland or the destruction of the thyroid gland with radioactive iodine

If you have either of these procedures done you will become reliant upon thyroid medication for life. 

Why?

Because your thyroid gland will no longer be functioning. 

Even medications for hyperthyroidism, such as Methimazole, may result in hypothyroidism if they are used in excess. 

#4. Pituitary & Hypothalamic Issues

Your pituitary and hypothalamus can be considered the master regulators of your hormones and that includes your thyroid. 

These organs are located in your brain and then sense what is happening in the body and respond by telling your body how much thyroid hormone you need. 

If they are damaged, for any reason, your thyroid may not get the signal and may not produce enough thyroid hormone. 

Even if your thyroid gland has the capacity to function correctly it won’t if it doesn’t get the signal. 

Conditions such as tumors (prolactinoma) (10) and extreme stress or trauma (11) can cause damage to the HPT axis. 

These are not very common causes but they should always be considered. 

These conditions are usually not reversible. 

#5. Iodine Deficiency

The only way that you can get iodine is from your diet and if you don’t get enough you may develop a condition known as a goiter. 

This is because iodine forms the backbone of all thyroid hormones floating around in your body. 

If you don’t have enough iodine then your body won’t be able to produce enough thyroid hormone (12).

One of the problems with iodine consumption is that we really only get it from very special foods such as sea vegetables and iodized salt.

Your body needs up to 150-200mcg of iodine each day and if you don’t get enough you may be at risk for iodine deficiency. 

The good news is that this condition is readily treated once you give your body back what it needs!  

You can learn more about iodine supplementation here. 

#6. Pregnancy & Lactation

Pregnancy and lactation don’t necessarily cause hypothyroidism by themselves but they lead to it indirectly. 

Both conditions put an increased strain on your body to produce more thyroid hormone because you are effectively producing it for two people!

So, if you have any minor deficiencies or problems, these issues may be exacerbated by lactation or by pregnancy. 

As they are exacerbated you may start to experience the symptoms of hypothyroidism even though you technically have enough thyroid hormone for “you”. 

These conditions can usually be treated with thyroid hormone while you are pregnant or breastfeeding and the medication can usually be stopped afterward (13).

#7. Congenital Issues

Occasionally, someone may be born without a thyroid or with an issue relating to thyroid function. 

These problems are not reversible but luckily they are quite rare and they can be treated with thyroid medication. 

How to Focus Your Treatment

So what are you supposed to do if you have thyroid disease?

The first step is to try and find out what is CAUSING the issue. 

You can do this by ordering a complete set of thyroid lab tests designed to look at all stages of thyroid function. 

The complete thyroid panel will give you information about how your brain is functioning, and how your thyroid gland is functioning and give you insight as to how well thyroid hormone is working at the cellular level. 

During this process, you may also need other tests such as insulin, leptin, and other sex hormones. 

Don’t let this seem intimidating! 

If it does then you should actively seek out a physician who is willing to help guide you along the way (you can find resources on how to do that here). 

If you can find out what the main cause of your symptoms is then you can usually determine if you have hypothyroidism or simply thyroid dysfunction. 

In your workup, you may find that you have multiple causes of thyroid dysfunction, which isn’t uncommon, and areas that you need to treat. 

If this happens to you then you can pick one and treat that issue and then systematically move down the list until you’ve “fixed” all major issues. 

As you do this you should feel better and better. 

Conclusion

There are many different causes of both thyroid dysfunction and hypothyroidism. 

Finding out the cause of your thyroid disease is probably the single most important step you can take to feel better. 

Finding this information will help direct your treatment and may allow you to reverse your condition (in some instances)

Now I want to hear from you:

Are you suffering from thyroid dysfunction or hypothyroidism?

Do you know which issues may be causing your thyroid disease?

Have you taken steps to address these issues?

Why or why not?

Leave your comment or questions below! 

Scientific References

#1. https://www.ncbi.nlm.nih.gov/pubmed/7641412

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254573/

#3. https://www.ncbi.nlm.nih.gov/pubmed/6479377

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/

#5. https://www.ncbi.nlm.nih.gov/pubmed/12055988

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC377492/

#7. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(74)92070-4/abstract

#8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784889/

#9. https://www.ncbi.nlm.nih.gov/pubmed/27051079

#10. https://www.ncbi.nlm.nih.gov/pubmed/27105040

#11. https://www.ncbi.nlm.nih.gov/pubmed/16020927

#12. https://www.ncbi.nlm.nih.gov/pubmed/16704348

#13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2425446/

14 causes of thyroid disease: find your root cause
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