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5 costly mistakes thyroid patients make

5 Costly Mistakes Thyroid Patients Make (& How to Avoid Them)

As thyroid problems continue to become more and more common among patients of all ages, it’s important to have a complete understanding of what this means for your body.  Unfortunately, the standard approach to treating thyroid conditions is more focused on the benefits of the Doctor and not necessarily the patient.  But, with a little …

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are you destined to be overweight forever

Are You Destined to be Overweight Forever? (The Answer is No)

This is a question that I’m sure many of you think about. Perhaps you’ve even given up on the idea of getting back to a ‘normal’ weight. The truth is that there is definitely a chance for you to get back to whatever is normal for you, even if you suffer from hormone imbalances such …

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is synthroid gluten free?

Is Synthroid Gluten-Free?

Are you actively trying to avoid gluten-containing foods? Do you also have hypothyroidism? If so, then this article is perfect for you.  I’m going to jump the gun and tell you that Synthroid is indeed gluten-free, but it may contain other ingredients that can cause issues.  We are going to discuss the gluten content of …

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Experimenting with 1 Trillion Probiotics 10 Day Gut Cleanse

Experimenting with 1 Trillion Probiotics: 10 Day Gut Cleanse

I’m a big fan of experimenting with my own health.  In fact, most of the strategies and therapies that I’ve developed have been as a result of testing them on myself and then family members.  Today, I’m going to explore my experience using high-dose probiotics for 10 days straight.  I took 1 trillion CFU of …

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

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

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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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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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
Is Natural Desiccated Thyroid (NDT) the Best Thyroid Medication?

Is Natural Desiccated Thyroid (NDT) the Best Thyroid Medication?

Natural desiccated thyroid is a thyroid medication that comes from pigs!

This medication contains a more “complete” profile of thyroid hormones when compared to almost all synthetic thyroid medications out there. 

This has led many people to tout NDT as the “best” thyroid medication. 

In this article, we are going to explore this claim while also discussing the pros and cons of this medication. 

You’ll learn who should use this medication, who should avoid it, and the pitfalls of using it

Let’s dive in: 

What is NDT or Natural Desiccated Thyroid Hormone?

NDT or natural desiccated thyroid hormone is simply a type of thyroid hormone medication. 

It can be used to treat people who have low levels of thyroid hormone in their body from conditions like Hypothyroidism and Hashimoto’s thyroiditis. 

NDT is often claimed to be one of the “best” thyroid medications out there because it’s considered to be all-natural. 

So, with this in mind, let’s break apart what NDT actually is. 

First:

Where does NDT come from?

NDT is porcine-derived which means that it comes from pigs. (1) 

To get NDT, people must take the thyroid gland of pigs and desiccate or dry it out. 

From there it is standardized to a specific dose and contains 38mcg of T4 (the inactive thyroid hormone) and 9mcg of T3 (the active thyroid hormone) in each grain. 

Grain is just a way to standardize the dose of NDT between different brands. 

Natural desiccated thyroid also contains other hormones and prohormones such as other types of thyroid hormone (T1 and T2).

These hormones are not nearly as active as T4 and T3 but they are thought to play an important physiologic role in the body otherwise, (2) why would your body produce them?

Each grain of NDT contains around 76% T4 and around 23% T3 which is a ratio close to the 80% T4 and 20% T3 that your thyroid produces naturally when it is healthy. 

For this reason, and because it contains prohormones, and because it comes from a natural source, (3) many people believe it is one of the most complete thyroid medications out there! 

While this may be true, it doesn’t mean that it works equally well for every single person. 

Let’s dig into the basics of NDT and talk about why it may not be the best medication. 

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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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Natural vs Synthetic Hormones

NDT is considered to be natural because it is sourced from a “natural” source, pigs. 

This sourcing of thyroid hormone is different from the approach used to create other formulations of medications such as Levothyroxine and Synthroid

Other medications are created in a laboratory from other basic compounds. (4) 

But you must always remember that ALL types of thyroid medications are considered to be bio-identical which is very important. 

Bio-identical means that the hormones you are taking by mouth are considered to be IDENTICAL to the hormones that your body produces naturally!

Where these medications differ is in the SOURCE. 

The source for NDT is from pigs while the source for Levo and Synthroid is other chemical structures. 

Some people believe that naturally sourcing thyroid hormone is superior to creating it chemically in a lab. 

From my perspective, there is no difference between thyroid hormone from a human or a pig when compared to thyroid hormone created in a lab

Both compounds look the exact same and function in a similar way in the body. 

Where they differ is in the other hormones and pro-hormones that come in NDT formulations. 

NDT Brands

Let’s take a second to discuss the various brands of natural desiccated thyroid hormones out there. 

There are several “well-known” brands and some less well-known brands. 

What you need to understand is that these medications do differ in the type of active and inactive ingredients in them but they all contain both T4 and T3 thyroid hormones. 

While it may not sound like the inactive ingredients make a big difference, they actually may be the reason that some people simply can’t tolerate certain types of NDT brands. 

For instance:

It’s not uncommon for someone to be on Armour thyroid but not feel well when switching to NP thyroid even if their dose stays the same. 

These differences are likely the result of how your body interacts with the inactive ingredients and how difficult it is for your intestines to break down and absorb the hormones in the medication. 

What that means for you is that if you don’t tolerate one type of NDT brand it doesn’t mean you won’t tolerate all of them. 

Instead, you may want to switch to a couple of different brands to see if you can find one that works for you. 

With that in mind, you can find a list of NDT brands below: 

Is NDT Superior to T4 Medication for Hypothyroidism?

It is largely felt by many online communities that natural desiccated thyroid is the single “best” thyroid medication out there. 

This logic has led people to believe that if you are taking NDT and it isn’t working for you that the problem must be with your dose and not with the medication itself. 

I’m not a fan of this approach and don’t believe that when it comes to your thyroid that there is a single “best” thyroid medication

A better approach is to always listen to your body while you look at other problems beyond your thyroid

Thyroid tunnel vision can lead you to believe that every problem you have is associated with your thyroid and that adjusting your dose is the solution to this problem. 

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This approach to management has led many patients to take higher than necessary doses of thyroid medication which can be dangerous! 

So, while NDT is a great medication, it’s certainly not the “best” or the only thyroid medication available. 

The type of thyroid medication that you use, and your dose, should be individualized to YOUR body. 

Natural Desiccated Thyroid for Weight Loss

One important note worth mentioning is that of weight loss and NDT. 

Some studies, like this one, have shown that switching to NDT does result in modest weight loss in certain patients. (5) 

This particular study took a look at 70 patients that were already taking T4 medication (Levothyroxine). 

This group of patients was taking this medication and despite having a normal TSH still had some symptoms of hypothyroidism. 

Thyroid lab tests in patients taking natural desiccated thyroid compared to T4

These patients were then randomized and given NDT (desiccated thyroid extract) for 16 weeks and then placed back on their old medication. 

During the period that these patients were taking NDT, they noticed around a 3-pound weight loss on average and roughly 50% of patients taking NDT wanted to stay on it. 

Not only did they lose weight but they also reported feeling much better on the medication in a subjective sense (based on their own opinion). 

3-4 pounds may not sound like a big deal to you, but when you realize that weight is incredibly difficult to lose when you have hypothyroidism this is actually a great feat. 

But does this mean that the weight loss is due to NDT itself or simply due to the T3 in the medication?

While we don’t have definitive studies, it’s logical to believe that the same results would have been achieved by simply adding T3 (in the form of Cytomel or Liothyronine) to existing doses of T4 in these patients. 

So, while NDT can certainly help you lose weight if you have hypothyroidism, don’t fall into the trap of believing that the weight loss is caused by the NDT itself. 

Instead, the weight loss is most likely the result of IMPROVING the total T3 and free T3 levels in your body! 

And this can be done with T3 medication of any type. (6) 

Common Problems and Symptoms when using NDT

Let’s talk about some of the problems associated with NDT use. 

The way that your body responds to NDT is going to be different from other people out there. 

This means that the type of NDT that you use, and the dose that you use, all may potentially lead to problems. 

What’s important is to focus on how YOU feel and how YOU tolerate the medication. 

By listening to your body, and by checking your thyroid lab tests, you can be certain that you are taking the right dose for your body. 

You can find a list of the most common problems that patients experience when they use NDT below: 

  • Some people take too much natural desiccated thyroid hormone – (7) Overdosing on NDT is a common problem because many people believe that higher doses will somehow improve their thyroid function. This leads to overdosing and symptoms of hyperthyroidism in some patients. This problem stems from “thyroid tunnel vision”.
  • Dosing is static which means you can’t tweak the T4 and T3 concentrations – NDT comes in a static dose of 38mcg:9mcg of T3. This means that you can’t individually adjust the amount of T3 in the medication without also adjusting the T4. You might do great on 38mcg of T4 but may need something like 5mcg of T3. If you fall into this category then you can’t adjust your medication. 
  • May lead to variations in free T3 & Free T4 levels – Some people experience very high free T3 levels and very low free T4 levels even when using low doses of NDT. This problem probably has to do with how each individual processes thyroid hormone in their body. 
  • Symptoms arise from the use of T3 which can be difficult to manage in some patients – (8) Some patients are exquisitely sensitive to even incredibly low doses of T3. These are patients that would probably do fine on certain types of T4 medication (such as Tirosint) but do poorly when they start even low doses of NDT. 
  • May be hard to break down for some patients in the intestines – This problem isn’t unique to NDT medications, but it’s worth considering if you have intestinal issues. Inactive dyes and fillers may cause reactions and may make the digestion of NDT difficult. 
  • May lead to immunogenic reaction (may not be ideal for patients with Hashimoto’s) (9) – There is a theoretical risk that taking a foreign pig-derived substance can “flare” up the immune system and worsen thyroid function in patients with Hashimoto’s thyroiditis. I don’t think this is a reason to completely avoid NDT if you have Hashimoto’s thyroiditis but you should be aware that it can happen.

Overdosing on NDT

Believe it or not but doctors have been using NDT since the 1950s!

Even back then it wasn’t uncommon for doctors to prescribe high doses of NDT (up to 3 to 8 grains per day) to patients. (10)

This was way before thyroid lab tests were created, so dosing was often based on the “Basal metabolic rate” which is a marker for metabolism. 

These doctors found that increasing the dose of NDT did result in modest weight loss by increasing the metabolism, but once the dose was lowered, the metabolism of the patient went back down to below-normal levels. 

This is as relevant today as it was back then. 

Currently, many people believe that by simply increasing their dose of NDT that they will finally feel better and relieve their symptoms. 

This happens frequently in patients who are suffering from weight gain. 

This leads to higher and higher doses of NDT which dramatically suppresses the TSH and temporarily helps with weight loss. 

But the unintended effect is that it may also cause long-term harm because of the high dose of NDT being used. 

Studies dating back to the 1950s showed that if you are responsive to NDT you only need a small dose (usually 1-2 grains) to improve your symptoms and improve your metabolism. (11) 

If you are still feeling symptomatic at that point then some of your symptoms are likely related to some other problem or some other hormone imbalance!

You can avoid these potential negative side effects by using only the appropriate dose and by monitoring your thyroid lab tests in the process. 

Who should use NDT

NDT is a great medication and many people out there stand to benefit from its use. 

I’ve compiled a list of just some of the patients that tend to do the “best” on this medication below: 

  • Those who have failed T4 medication – If you’ve been on T4 medication such as Levothyroxine or Synthroid and you just aren’t feeling well after 6-8 weeks then it may be time to consider a T4/T3 combo medication. 
  • Those with low free T3 levels (usually need a T3 medication) – Up to 15% of the population suffers from thyroid conversion issues which means they don’t convert T4 into T3 as well as other people. If you fall into this category you may have a “normal TSH” but your free T3 and total T3 levels may be lower than normal. If you fall into this category then adding T3 (from either NDT or Liothyronine) may help bring these levels up and help you feel better. 
  • Those who are post-thyroidectomy – Your thyroid (when functioning normally) produces around 80% T4 and around 20% T3. If you don’t have a thyroid, because it was removed or destroyed, then it makes sense to supplement with thyroid hormones close to this ratio. Most post-thyroidectomy patients take only T4 medications (so 100% T4) which do not contain T3. Some of these patients don’t feel well despite having a normal TSH. Taking NDT can provide your body with T3 in a ratio that is close to what your body produces naturally and may help those without a thyroid. (12)

This is not an all-inclusive list but it can help get you started! 

Conclusion

Natural desiccated thyroid is a thyroid medication that contains both T4 and T3. 

Because of this, it may be one of the better thyroid medications (but not the best!) out there. 

If you have thyroid issues and are struggling with low free T3 levels, weight gain, and/or other symptoms despite having a normal TSH, then this medication may help you

When using it be careful to watch for side effects such as anxiety, heart palpitations, or hot flashes which may indicate that your dose is too high. 

Now I want to hear from you:

Are you taking NDT? Is it working for you?

Are you not tolerating NDT?

Is it causing negative symptoms?

If so, leave your comments or questions below!

I’ll do my best to respond to each comment. 

Scientific References

#1. https://www.ncbi.nlm.nih.gov/pubmed/10365676

#2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272398/

#3. https://www.ncbi.nlm.nih.gov/pubmed/15253676

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146262/

#5. https://www.ncbi.nlm.nih.gov/pubmed/23539727

#6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965938/

#7. https://www.ncbi.nlm.nih.gov/pubmed/29942726

#8. https://www.sciencedirect.com/science/article/pii/B9780323189071000883

#9. https://www.ncbi.nlm.nih.gov/pubmed/9545109

#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1642898/?page=1

#11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980994/

#12. https://www.ncbi.nlm.nih.gov/pubmed/23072197

are natural thyroid medications really better
Why is there so much controversy surrounding thyroid treatment

The Thyroid Controversy: Where Doctors Go Wrong

This is lesson #2 in my thyroid beginner series which is primarily designed for those who are building a foundation of knowledge in thyroid dysfunction or for those who have recently been diagnosed. 

Today we will be discussing why there is so much controversy surrounding thyroid treatment and why it can be difficult to get your doctor “on board”. 

Watch the video above for more info or read the text below if you prefer as well!

Please leave your questions in the comment section below so I can go over them in the next video!

Thyroid Controversy: Integrative vs Conventional Treatment

Why are so many thyroid patients unhappy with their current treatment?

Is it possible that our current approach or understanding of thyroid management is flawed?

I think this answer can be addressed by simply looking at how we approach and manage thyroid dysfunction and comparing that to other ways that we look at hormone imbalance in the body. 

Patients often find themselves in an unfortunate situation:

They have been diagnosed with thyroid issues and are experiencing thyroid symptoms even though they are already taking thyroid medication

If you fall into this situation you might be asking yourself this question… 

How is it possible for me to feel so terrible when my Doctor keeps telling me that my thyroid is “normal”?

And this is the thyroid controversy in a nutshell and it comes down to how Doctors look at and manage the thyroid.  

This approach to thyroid management has left thyroid patients frustrated which leads them to seek help on the internet, on forums, and on Facebook groups. 

With this in mind let’s take a look at how conventional doctors approach thyroid management and compare that to integrative doctors. 

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How Conventional Doctors Look at Thyroid Treatment

The standard and conventional approach, the approach that is taught in medical schools and residencies, is actually quite simple. 

I’ll outline it to you below (this is the way that I was taught and the way that most doctors are taught): 

  • If thyroid disease is suspected then check for a lab known as the TSH (thyroid stimulating hormone). 
  • If the TSH is high (defined as outside of the lab reference range) then initiate treatment. 
  • Treatment should always be done with T4-only thyroid medications such as Levothyroxine, Synthroid, or Tirosint
  • Adjust medication until the TSH is somewhere around 1.0 to 2.0. 
  • Any other symptoms related to thyroid disease (such as fatigue, weight gain, depression, constipation, cold skin, etc.) must be related to some other cause if the TSH is normal
  • Make adjustments to thyroid medication based on the TSH which is tested every 2-3 months. 

The main problem with this approach is that it is too rigid to allow for variability among patients. 

For instance:

How is it possible that all thyroid patients can do well on one medication?

Even when treating diseases such as cholesterol and high blood pressure Doctors have several sets of medications (1) that they will use and play around with but when it comes to the thyroid they are set on using one medication. 

Is it possible that some patients differ in their ability to utilize thyroid medication?

Some patients may react to the fillers or dyes in certain medications or vary in their ability to absorb medication from gastrointestinal issues. 

Problems such as lactose intolerance, Celiac disease or SIBO (2) can all influence how the body absorbs these medications. 

Is it possible that genetics may play a role in which medication works best for each person?

Doctors have no problem ordering genetic tests which outline how you metabolize anti-depressants, but they fail to consider that individuals can vary in how they metabolize hormones in the body. 

It is well known that individual genetics impact the pharmacokinetics and pharmacodynamics of medications and hormones in the body (3)!

These are just some of the reasons that taking such a rigid approach doesn’t make sense from a logical standpoint, but there are other reasons as well. 

Does Focusing on the TSH Make Sense?

The reliance upon TSH as a sole marker for thyroid function may not make sense when you compare it to other pituitary hormones and how Doctors treat those issues. 

To understand this let’s briefly discuss what TSH is and how it works:

TSH is known as thyroid stimulating hormone and it is secreted by the pituitary gland in your brain. 

TSH acts directly on the thyroid gland to stimulate the release of thyroid hormone (4).

So the higher your TSH is the more “stimulation” your thyroid gland gets and the more hormone your produce. 

But TSH isn’t the only hormone that is secreted by the pituitary gland which acts in a similar way. 

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Hormones such as LH, FSH, and ACTH all act to “stimulate” other organs to release their target hormones

But what’s interesting here is that whenever we look at other hormones, such as testosterone, we don’t care what the pituitary stimulating hormone level is, we care about the level of the hormone in the body (5)!

For instance:

If you feel that you have low testosterone in your body would it make sense for your Doctor to check your pituitary stimulating testosterone hormone or to directly check testosterone levels in the body?

Logically, it makes sense to check for the hormone. 

But that’s not what we do with the thyroid. 

Instead of looking at the hormone levels in your body, we check for the pituitary-stimulating hormone TSH. 

And instead of adjusting the dose based on how much hormone is in your blood, conventional doctors adjust it based on the TSH. 

But there’s a problem with that:

Studies have shown that patients who are treated with T4 thyroid medication to a “normal” TSH still have lower than normal free thyroid hormone levels which may account for the trouble that many patients experience. 

This can largely be solved with the use of both T4 and T3, but physicians still refuse to use these medications.

But back to the way that physicians normally dose and look at other hormones in the body for a minute. 

Consider these examples:

The TSH still has value and still should be checked in patients, but it may not be the single best marker to assess thyroid function in your body. 

How Integrative Doctors Look at Thyroid Treatment

So now that you understand how conventional Doctors (endocrinologists and primary care physicians) look at thyroid management we can compare that to how more integrative doctors evaluate patients with thyroid disease. 

And by integrative doctors, I am referring to doctors that may have extra training (outside of residency) in anti-aging medicine, integrative medicine or functional medicine. 

The problem with this type of training is that it is not “standardized” which means that not all “integrative doctors” look at each patient the same. 

Some doctors have used the term functional or integrative as a marketing tactic to simply get more patients even though they may not use a different approach from conventional physicians. 

But in an ideal world, your doctor should be evaluating you in the following way: 

  • Test for more than just the TSH – When evaluating your thyroid your free thyroid hormones (T3 and T4) give valuable insight as to how your body is absorbing and converting thyroid hormone. These free thyroid hormones (according to newer studies) track more closely with better outcomes when compared to other factors. 
  • Take into account individual genetics and preferences – Certain individuals are not able to convert or activate thyroid hormone at the same rate as others. SNPs in genes that control deiodinase enzymes can impact how you respond to T4-only thyroid medication (9). It is estimated that up to 15% of the population varies in their ability to convert T4 into the active T3 thyroid hormone. 
  • Take into account environmental factors such as stress, sleep, and diet – Lifestyle factors impact not only your thyroid but other hormones in your body as well! Your doctor should be treating you with more than just medications and supplements and should focus on the food that you put in your mouth and how you manage your stress. If they don’t address or ask about these questions then it may be time to seek a second opinion. 
  • Use more than just T4-only thyroid medications – In terms of thyroid medications, there is much more than just Synthroid and Levothyroxine. Other medications include NDT and T3/Cytomel/liothyronine. These thyroid hormones can be safe and incredibly effective if used appropriately. 

As a patient, which approach would you rather have?

The rigid approach of conventional medicine is algorithmic, and the more individualized/integrative approach which is fluid and dynamic. 

So What are you Supposed to Do? 

So what are you supposed to do if you feel terrible and your Doctor isn’t willing to work with you?

Learning and reading are steps in the right direction, but it’s not a substitute for a knowledgeable doctor who can guide you through the process. 

Your best bet is to seek out a physician who can help you and one who takes this more integrative approach. 

Unfortunately, these types of doctors can be very difficult to find and they often don’t take insurance. 

In order for these doctors to obtain this type of knowledge they usually have to do extra work and training after residency. 

This means that not all physicians are equal in their understanding of these concepts which means they can be difficult to find. 

I’ve put together a resource here that you can use to help find a knowledgeable physician in your area

Before you ask, I don’t know any or have personal recommendations to give you, or I would do so happily!

Because physicians have to learn this on their own we don’t have a secret group where we all talk or discuss patients. 

Conclusion

If you are struggling with your current thyroid management then it may be time to seek out a second opinion. 

Patients who have gone this route often report an increase in quality of life, an increase in energy, a reduction in weight, and many other benefits. 

Don’t waste the best years of your life with physicians who don’t take your complaints and symptoms seriously!

Life is too short and your health is too important. 

Now I want to hear from you:

Are you struggling with the current conventional approach?

Do you have questions about the integrative approach?

Which has worked for you? Which hasn’t?

Leave your comments below! 

#1. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072414/

#2. https://www.ncbi.nlm.nih.gov/pubmed/28153426

#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299682/

#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433956/

#5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772354/

#6. https://www.ncbi.nlm.nih.gov/pubmed/393456

#7. https://www.ncbi.nlm.nih.gov/pubmed/3139571

#8. https://www.ncbi.nlm.nih.gov/pubmed/6323158

#9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1578599/

the thyroid controversy explained: where doctors go wrong
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