In this episode of #AskSonia I talk about my 20 year journey with Hashimoto's hypothyroidism. How it took over 10 years to work out why I was so freaking tired all the time, foggy in the brain and aching in my joints and muscles.

In this episode of #AskSonia I talk about my 20 year journey with Hashimoto's hypothyroidism.

How it took over 10 years to work out why I was so freaking tired all the time, foggy in the brain and aching in my joints and muscles. Then once I was diagnosed with Hashimoto's hypothyroidism how the medication I took failed miserably to gift me my energy & quality of life back. I continued to feel exhausted, gained weight, lost my memory and was sleeping 5 days a week just to be able to go to work for 2 days.

And now brimming with energy, vitality and my lust for life returned I am passionate about no one ever having to suffer through what I experienced with Hashimoto's hypothyroidism. Especially because there are a wealth of solutions based on high quality scientific research drawn from nutrition and natural remedies.

This channel came into being because as a clinical nutritionist and naturopath, more often than not I've quite a long waiting list and I would find that you know it might take someone six weeks before they saw me and when they did they had some pretty straightforward questions that I could have actually answered not even by meeting them by but just by having some information that was freely available so that kind of made me very passionate about creating this channel. I want to tell you a little bit about my story and how I came to specialise in thyroid and women’s hormones.

20 years ago I was at the absolute peak of my career. I was thriving in an international luxury goods company and loving my life. I had the partner that I wanted, the job that I wanted and a lifestyle that I just adored and yet every day I was waking up exhausted. I was crying at the drop of a hat, I really struggled to remember things. I actually think that was probably the most important symptom for me was really struggling with memory. I just would forget to turn up to meetings even if it was in my diary and whenever I tried to exercise I seem to get injured almost immediately and it was really disturbing. So I went off to see a local medical practitioner or a general practitioner, a GP and he ran some tests and he told me there was nothing wrong and I spoke to a few people and they said, “Oh it sounds like you've got a thyroid condition.” So I went back and said, “Would you mind testing my thyroid?” and he did and he said, “Look there is nothing wrong with you. You are a perfectly healthy young lady. It's just that you've got a busy life and lifestyle and you have to accept that you're starting to age now.”

I was in my late 20s at that time and it was a real shock to me to hear the word ageing because I'd never thought about it before and I actually felt fit and healthy and apart from this constant bad memory and just getting injured a little bit, I didn't realize that it could be related to an underlying condition so what I heard really was someone tell me that I was being a princess, that I was being a little bit too snow flaky, a little bit too fragile and what I needed was to just toughen up and get on with life; that everyone around me was feeling just the same way I was, it's just they weren't complaining about it and I was so like the good girl that I decided to do that head down, tail up and just ignore how I felt, drink some more coffee, eat whatever I had to eat just get through the day and I did that for almost a decade. It wasn't until my weight rapidly increased and I put on about 50 pounds / 20 kilos in a very short period of time with no change in my food or exercise. In fact, I was kind of less hungry than usual so I thought I was actually eating less and couldn't believe that would be happening and this time because the sign was so clear this weight gain, it drove me back to the medical professional and I ended up being diagnosed with a thyroid condition caused by an immune condition called Hashimoto's Hyperthyroidism.

I was put on thyroid medication and to be honest I was euphoric because there was a reason why I was tired, there was a reason why I was gaining weight, there was a reason why my brain was foggy and I had so much hope for the medication that I was on I really thought that this was going to cure me of all ills. Unfortunately, a few years went on and I felt no better.

I appreciate and recognise that the thyroid medication I was on kept me alive but unfortunately it didn't help with the weight gain which continued, the fatigue or the brain fog and by the time that I decided to take control of my health I was only working two days a week and I would have to sleep for five days to kind of drag my sorry carcass through a workday two days a week. Things were pretty bad and so I went back to my doctor, again and again, saying, “Hang on, I'm not feeling any better,” and I was referred to some amazing specialists. I was referred to an endocrinologist and immunologist, a rheumatologist and I ended up on a whole host of medications and still not feeling any better.

I went back to my GP and he said you know what now we need a psychiatrist because quite frankly there's nothing wrong with you you're being treated well this is now just all in your head and actually I'm grateful for that conversation because that finally woke me up after all those years. I started to think, hang on there must be something I can do to take some control back there must be something I can do to make myself feel better so I decided to start researching the natural health world and I saw nutritionists and naturopaths and kinesiologists and crystal healers and Reiki therapists. I spent a lot of money and a lot of time and I don't know that I really felt that much different, maybe a little better I'm not sure and it wasn't really until I decided to find out why I was feeling the way I was and what I could do and I started researching that I actually started to get a sense that it could get better. So I was on the internet researching thyroid conditions and the other autoimmune conditions that I've been diagnosed with by this stage and I found that there was a wealth of information on the Internet, you know lots and lots of information way more than what I was getting when I was going off to therapists and doctors and specialists but it was confusing. I’d see one post and they'd say, ‘oh my goodness if you've got a thyroid condition you must have iodine in huge quantities’ and then I'd read another post and they go, ‘oh for goodness sake don't have iodine, it could kill you if you have a thyroid condition, it's appalling you know it's you should never have too much it could make your thyroid condition worse.’

I was so confused — I mean I already had brain fog — so it was really hard to wade through it and I just thought to myself hang on these posts or these comments must be based on something you know, there must be something underlying them and I found that there were websites devoted to scientific research and that thyroid conditions and Hashimoto's hypothyroidism and hormonal conditions and other autoimmune conditions had all been extensively studied and there were nutritional solutions and herbal solutions that worked well with medications that helped people feel better and so it was like mind-blowing.

I come from the corporate world, and my background was in human resource management. I don't know how to read a scientific journal so I decided to go back and study and so I signed up for a four-year course on nutrition and naturopathy and I learnt evidence-based solutions based on high-quality scientific research. I learned how to read journal articles, how to evaluate statistics and when I started to make some really small simple changes in my own life, I had enormous payoffs. I just did them gradually one by one and it felt like every six weeks I would feel a dramatic improvement in my energy or my brain fog or my muscle aches and pain and after having felt increasingly more miserable for over 15 to 20 years, it was honestly like a miracle so I finished my four-year course, having won all sorts of awards but more important with than that was the fact that I had my health back.

I became really passionate about making sure that no one ever lives through what I lived through, no one ever loses the years and the decades of their life - wandering in a fog and a maze of ill-health when there are solutions out there that you can try.

The things I'm gonna talk about on this channel are going to be very straightforward. They will only be general because I can't give individual prescriptions but I'm really here for the purpose of education so I want you to enjoy this channel I want you to learn from it. Please let me know if there's something that you want to hear about because this channel is for you this is to make sure that the information that is available in the world is actually given to the thyroid communities where we really desperately need it.

Yours in good health,
Sonia x

This first episode of #AskSonia is a quick overview of my channel and how I help those with troubled thyroids & female hormones hijacking their health regain their energy, vitality & lust for life. If this sounds like you then let's start talking - I'd love to answer your questions!

If you're tired, forgetful and struggling with your weight well, I’m pleased to announce I’ve launched my very own YouTube channel.

I’ll be sharing videos to help you regain your energy, vitality and lust for life with high quality and scientifically researched nutrition and natural therapies that complement the very best of medical care.

This first episode of #AskSonia is a quick overview of my channel and how I help those with troubled thyroids & female hormones hijacking their health. If this sounds like you, then let's start talking - I'd love to answer your questions!

What do you want to know about Hashimoto's hypothyroidism or female hormones?

Yours in good health,
Sonia x

Is willpower and the motivation to exercise missing from the hypothyroid brain?

Hypothyroidism may cause fatigue, low mood, weight gain and muscle weakness.  Even when adequately medicated or thyroid hormone levels are said to be normal (medically referred to as euthyroid), often those with Hashimoto’s still experience symptoms. 

It’s this tragedy of the thyroid medication not leaving me feeling better that personally spiralled me into a dark cesspit of depression. Whilst I appreciate and recognise thyroid medication was keeping me alive, it didn’t improve my brain fog, fatigue, weight, muscle aches and pains nor tummy issues.

If you have been prescribed thyroid hormone but continue to suffer the signs and symptoms of hypothyroidism please start with thorough thyroid testing and matching your medication needs.

Once I learnt that Hashimoto’s itself may cause the same symptoms of hypothyroidism despite normal thyroid lab tests, and, that medication for some people does not relieve, remove or reduce the debilitating sensations of exhaustion, teariness and pain - I felt profoundly relieved.  Realising I wasn’t crazy, knowing I wasn’t alone in missing the miracle medication promised to provide, helped me move into solution mode.   

I was eager to try anything and everything scientists said might just help.

Turmeric latte? Got my curry on in a hurry.

Herbs, vitamins, minerals? Ka-ching I bought them all & swallowed them all.

Gluten-free? No problem - I’ll nosh on cardboard if it promised to return my quality of life!

And the outcome was miraculous for me. By the time I finished learning how to take control of my health via a 4 year triple qualification in nutritional medicine, herbal medicine and naturopathy I was bounding with energy and back working full time hours after previously barely coping with 2 days a week.  It was like someone had pulled back the curtains of fog clouding my brain with fatigue and pain to let in the sunshine and ease of a life worth living.   

So when I discovered the ocean of research on the healing power of movement I was swept up by the power of a king tide for the potential for further improvements. I joined a gym, dusted off my sneakers and thought I’d soon be in the running for a gold medal so keen was I to add this recovery strategy to my tool kit of solutions for my remaining thyroid symptoms.  

Exercise has been found to have significant impacts on helping with depression, chronic fatigue, muscle weakness and even constipation - all common Hashimoto’s and hypothyroid symptoms. 

But the reality was I found it almost impossible to stay disciplined after the first week of excitement waned. Getting off my comfy couch to “feel the burn” was a monumental task requiring a team of stevedores and a heavy lifting crane. My inner Jane Fonda circa 1980 had apparently retired her lycra g-string and leg warmers for good.

I had hit the frustrating point where I knew what I needed to do, but, I could not make myself do it.

Cue extensive mental berating and self-flagellation.  Stop being so lazy! You’re a failure! What sort of naturopath doesn’t love yoga? You’re the only herbalist alive who isn’t jonesing for a hike in the wilderness!

It wasn’t until I read the research on the motivation to exercise and learnt as humans we may be wired to sit on the couch as much as possible that I gave myself a time-out on the blame-game. 

It seems our brain may be trying to protect us from burning energy and calories by avoiding movement.  Even when people knew exercise was good for them AND they were genuinely planning to exercise their brains short-circuited the impulse nudging them to be inactive.

As Dr Matthieu Boisgontier, the lead researcher on the study said:

“Conserving energy was necessary for us as a species in our early days…. The fewer calories that (…) humans burned, the fewer they had to replace at a time when food was not readily available”.

Sitting quietly on a comfy couch is a survival mechanism and may be built into the architecture of our brains as humans!

Implications for Hashimoto’s hypothyroid heroes

This started me pondering… could the desire to not move or exercise be exacerbated and worsened when hormones are hijacking our energy levels?

Considering a sluggish thyroid means our body struggles already to burn calories and produce energy, could Hashimoto’s and/or hypothyroidism worsen and magnify the human tendency to inactivity?

Are men and women with sluggish thyroids losing out on the boosting impact of moving their body because their brain is shouting at them to stay couch-side in energy conservation mode? 

For me it was like finding the vital missing piece of jigsaw puzzle in terms of learning why I was not acting on my knowledge of the benefits of exercise. 

The way I transfer the learnings of this study into my life personally is when the ‘sluggish stay in bed sleep-ins’ or 'parking my posterior on the couch for posterity’ feelings start talking to me I deliberately and consciously don’t listen.

I’ve learnt I am not a failure because I am not motivated. I now recognise and realise it may be futile to rely on willpower to get me up and moving ‘cause, just like the elusive cleaning fairy, willpower may never visit my home no matter how hard I wish upon a star.

It’s very common for my Hashimoto’s and hypothyroid clients to share with me their experience with heart breaking negative emotions like guilt, disappointment and a sense of hopelessness around exercise. 

These incredible men and women successfully make many tough and unpalatable changes in their pursuit of energy and vitality, yet they feel like failures, because they are not motivated to move. Could they be experiencing a double dose of energy conservation mode and their brain is forcing inactivity in an effort to falsely protect their survival?

Bottom line:

Step 1 Test it

Make sure you know if your hypothyroidism is caused by Hashimoto’s antibodies.  How? Request a Thyroid antibody pathology test.  These are written on lab request forms as either Thyroid antibodies or Anti-TPOs & TgABs.

Step 2 Check it

If you are returning to movement after injury, illness or an extended leave of absence please always get a thorough physical and medical check up to make sure you know what your body can and should be doing. 

I strongly recommend engaging with an exercise physiologist and/or physiotherapist to tailor a personalised return to movement strategy for you.  Please.  The last thing you want to happen is to compound the fatigue of hypothyroidism and Hashimoto’s with a physical injury!

Step 3 Schedule it

My own personal perspective as a Hashimoto’s hypothyroid woman is my body / my mind may never experience the urge to exercise. And that is normal and ok. Yet knowing the real benefits to my health from regular movement I need to lock activity into my daily and weekly schedule as an unbreakable date with myself.  Whilst I literally may never, ever, ever feel like moving I’ve got to just do it.

Step 4 Move it

Whether it is dancing to your favourite soundtrack, walking your neighbourhood or simply pumping your arms at your desk you’ve gotta move it, move it.

I’d love to hear what you think. How have you managed the urge to stay couch-side?

In health and hormone happiness,

Sonia x

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References:

Cheval, B., Tipura, E., Burra, N., Frossard, J., Chanal, J., Orsholits, D., ... & Boisgontier, M. P. (2018). Avoiding sedentary behaviors requires more cortical resources than avoiding physical activity: An EEG study. Neuropsychologia, 119, 68-80. doi: 10.1016/j.neuropsychologia.2018.07.029  https://www.ncbi.nlm.nih.gov/pubmed/30056055

Watt, T., Hegedüs, L., Bjorner, J. B., Groenvold, M., Bonnema, S. J., Rasmussen, Å. K., & Feldt-Rasmussen, U. (2012). Is thyroid autoimmunity per se a determinant of quality of life in patients with autoimmune hypothyroidism?  European Thyroid Journal, 1(3), 186-192. doi:  10.1159/000342623  https://www.karger.com/Article/FullText/342623

When your thyroid is underperforming almost every part of your body becomes sluggish.  Hypothyroidism triggered ‘go-slow’ can see the bathroom scales creeping up even if you have not changed what you eat, how much you eat or your exercise routine. The much-lauded weight loss math of calories in (eat less) - calories out (exercise more) = weight may be wrong in hypothyroidism.

So when you are told your thyroid levels are correct because you have enough thyroid medication in your body, based on your most recent lab test, it is devastating to continue to gain weight.   

For most with hypothyroidism and Hashimoto’s the hoped-for, prayed-for begged-for thyroid medication miracle equation reads like:

•       Hypothyroid = weight gain

•       No longer hypothyroid as taking medication and have been told by my doctor I am taking enough medication = weight gain stops + possibly even weight loss starts. 

If the thyroid medication miracle equation math fails and your weight is not normalised the first place to start is to make sure your medication matches your needs.  Check out this article here for more information on what this means.

Scientists have been researching if the type of hypothyroidism medication can change the weight loss result and the answer seems to be YES. 

In fact, the lab test used as the marker of thyroid function, ’TSH’, may not be a good marker of adequate thyroid hormone replacement therapy for the hypothyroid and those with Hashimoto’s thyroiditis.  What research is showing is that whilst there may be enough thyroid hormone for the TSH lab test to be normal in those with hypothyroidism and Hashimoto’s their metabolism might still be sluggish which inevitably leads to weight gain with no change in either food or movement (Biondi & Wartofsky, 2012). 

Make sure the medication you are taking is not only just showing up in lab tests but actually showing up in your fat cells where you want it working! 

Talking with your Doctor

To help you in your conversation with your doctor here are two recent studies on weight and thyroid medication that might be a great place to start so you can choose whether or not the medication you are taking matches your weight loss goals.

Study 1: T3 synthetic thyroid hormone

T3 medication as compared with ‘gold standard’ synthetic T4 medication levothyroxine (L-T4) resulted in significant weight loss of 11.9kg with a significance of P = 0.009.

This study reported in the The Journal of Clinical Endocrinology & Metabolism included fourteen hypothyroid patients. T3 or L-T4 were administered 3 x day to achieve a target TSH from 0.5–1.5 mU/litre. Patients were randomized in this double-blind, crossover intervention (Celi, et al., 2011).

Study 2: Natural desiccated thyroid hormone

Desiccated thyroid treatment as compared with the synthetic T4 medication levothyroxine caused 3 lb weight loss with a significance of (P < .001). 

This study again reported in The Journal of Clinical Endocrinology & Metabolism was done on 70 hypothyroid patients aged 18–65 years who had been on a stable dose of levothyroxine T4 (L-T4) for 6 months. Patients were randomised to either desiccated thyroid or L-T4 for 16 weeks and then crossed over for the same duration (Hoang, et al., 2013). 

Talking Lab Tests

Make sure when you talk with your doctor you raise the topic of testing Free T4, Free T3 and ideally reverse T3 in addition to TSH as researchers Biondi & Wartofsky (2012) concluded: TSH even when within the reference range is not a sufficiently good marker of adequate thyroid hormone replacement therapy in hypothyroid patients. Whilst there may be enough thyroid hormone for TSH to be normal their ability to maintain their metabolism might still be diminished.

Bottom line:

If you are still gaining weight or struggling to lose weight but you have been told your thyroid is normal to make sure you have had tested:

1.   TSH, Free T4, Free T3 and reverse T3. For more information check out this article that explains what these measures mean.

2.   Talk to your doctor about whether or not trialling a different thyroid medication might work for you.

In health and hormone happiness,

Sonia x

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References:

Biondi, B., & Wartofsky, L. (2012). Combination treatment with T4 and T3: toward personalized replacement therapy in hypothyroidism?. The Journal of Clinical Endocrinology & Metabolism, 97(7), 2256-2271. https://pdfs.semanticscholar.org/1f05/33af337382745a8e57b1c58f21c9cc082ee3.pdf

Celi, F. S., Zemskova, M., Linderman, J. D., Smith, S., Drinkard, B., Sachdev, V., ... & Pucino, F. (2011). Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. The Journal of Clinical Endocrinology & Metabolism, 96(11), 3466-3474. https://www.researchgate.net/profile/Rene_Costello/publication/51593751_Metabolic_Effects_of_Liothyronine_Therapy_in_Hypothyroidism_A_Randomized_Double-Blind_Crossover_Trial_of_Liothyronine_Versus_Levothyroxine/links/59074ec40f7e9bc0d5946ccd/Metabolic-Effects-of-Liothyronine-Therapy-in-Hypothyroidism-A-Randomized-Double-Blind-Crossover-Trial-of-Liothyronine-Versus-Levothyroxine.pdf

Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. (2013). Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. The Journal of Clinical Endocrinology & Metabolism, 98(5), 1982-1990.  https://pdfs.semanticscholar.org/8a02/5f13a5c7bd8992475c21e5ad93d802c8546f.pdf

When you are told your thyroid is normal based on a lab test, but you still feel tired, teary, you’re losing hair and are gaining weight - it can be heartbreaking.  Heartbreaking to suspect how you are feeling now is as good as life gets and heartbreaking to realise your doctor won’t prescribe any more medication. 

I remember vividly being told my thyroid was normal and the fatigue and brain fog suffocating my life was therefore not related to my thyroid at all. I was barely able to get out of bed in the morning and I needed to sleep for 5 days to store up the energy to go to work at a job that should have been very easy 2 days a week. The only option I was given was psychological intervention and referral to a specialist for strong anti-depressants.

Oh, so what I am feeling is all in my head? I must be crazy…

It wasn’t until years later when I learnt I could order my own laboratory tests and paid the ridiculously cheap price of $40 AUD that I discovered the amount of active thyroid hormone (T3) circling in my body was severely deficient.  

I had so little of this active thyroid hormone (T3) in my body it was likely I was not able to efficiently use the foods I was eating to fuel energy production in my brain cells, hair cells and fat cells. No f$%^g wonder I was exhausted and freezing cold on all but the hottest of hot summer days.

It wasn’t in my head, I wasn’t crazy - this was real.

So when I have clients now tell me they have been told their thyroid is normal I encourage them to:

1.   Test a little more thoroughly

2.   Depending on the results of their comprehensive standard pathology find a doctor that will engage in a conversation around supporting their health with medications that are available and that may be better suited to their own specific situation.

Then once their thyroid medication has been optimised:

3.   Tidy up and resolve any remaining symptoms they continue to experience - medication does not solve all problems. I wished upon this star for years that medication would cure all my ills before I fully appreciated for me, living a life free of all symptoms meant, taking control of what I eat, how I move my body and the way I manage my stress levels. 

4.   Address the possible causes of the hypothyroidism to make sure they are not vulnerable to more autoimmune conditions developing.  Autoimmune conditions like to entertain and party together. Once one of them appears it is common for more of them to cluster in and take up residence. Within 6 months of being diagnosed with Hashimoto’s, I had also been diagnosed with a total of 5 autoimmune diseases.  Investigating and removing the possible triggers for autoimmunity may prevent the cascading effect of autoimmune clusters.

Get Your Medication To Match

When you are tired, teary and overweight and medicated it is vital to start here - making sure you are taking the type of medication that matches what your body needs.   

In general, when you are on thyroid medication you will be taking levothyroxine which is synthetic thyroxine or synthetic T4.  This medication has different names depending on brand names used by pharmaceutical companies. If you are not sure if your medication is T4 only here is a non-exhaustive list of brand names by country:

USA: Synthroid, Levoxyl, L Thyroxine, Levo T, Levothroid, Levothyroxine T4, Levoxine, Tirosint, and Unithroid

UK: Eltroxin Advanz, L-Thyroxin, Actavis, Almus, Northstar, Teva

Australia: Oroxine, Eutroxsig & Eltroxin.

Step 1. Test 

For some with hypothyroidism and Hashimoto’s the traditional ‘gold standard’ of testing TSH and prescribing the medication synthetic T4 is not enough. 

Before we talk about options let’s clear up some of the thyroid-specific language I’m going to use. 

How thyroid hormone is made:

Your brain makes the thyroid-stimulating hormone (TSH). TSH is a messenger that talks to your thyroid gland.

↓

TSH travels to your thyroid, a small butterfly-shaped gland in your neck, and tells it how much thyroid hormone to make.

↓

Your thyroid makes T1, T2, T3 and T4 plus calcitonin. At this stage of medical knowledge we really only know what T3 and T4 do specific to thyroid and body functions so it is on these we focus.  We’re not interested in calcitonin for this discussion.

T4 is only made by your thyroid gland and is the storage form of thyroid hormone. Think of T4 as the ingredients of a meal like a bag of dried lentils and a raw sweet potato. You cannot eat them as they are in their raw state but with a little effort, time spent cooking plus a few other additions, you can make a meal.

T3 is made both by your thyroid gland and from the conversion of T4.  T3 is active thyroid hormone. Using the same food example, T3 is like the cooked meal of lentil and sweet potato soup you can eat immediately and provides you with energy. 

T4 can also make another hormone called reverse T3 (rT3).  RT3 is like someone stealing the food off your plate or someone putting their hand over your mouth as you are trying to eat your dinner. The end result of a high rT3 score is you are not able to access all of your active thyroid hormone T3. 

Alrighty, let’s go back to talking about testing.

When testing your thyroid function in Australia, USA and the UK mostly the measure TSH is used.  This is generally what is judged when you are told: “your thyroid is normal”. 

For me and for many of my clients unfortunately whilst our TSH might be within reference range our T3, active thyroid hormone, is too low and/or our rT3 is too high. This means (for the reason which I’ll talk about elsewhere otherwise this post will be as long as War and Peace) our body is not efficiently cooking and converting our storage raw T4 into active cooked T3.  

Just like eating hard lentils and uncooked sweet potato is not delicious neither can all of your cells use raw T4 for energy.  When there is not enough of the cooked version of thyroid hormone, T3, your cells can go hungry not getting enough to fuel their activities. Leaving you with hair cells making less hair and hair poorer in quality. This can be happening to any part of your body from your eyelashes to your toenails.

In fact, scientists have found in recent animal experiments only the combination of T4 and T3 replacement, and not T4 alone, ensures normal functioning in all cells and tissues in the hypothyroid (Wiersinga, 2001).

This means if we are only taking T4 medication or synthetic thyroxine and our T3 is too low or not able to be used by our body seen with high rT3 we may continue to experience hypothyroid symptoms like fatigue, brain fog, weight gain, constipation, weak muscles, hair loss, dry skin, puffiness, heavy periods and infertility. 

Step 1: What to test

TSH, Free T4, Free T3 and reverse T3 these are generally written on a pathology request form as TSH, FT4, FT3, rT3.  

Increasingly this is being proven in scientific research as well.  Let’s have a look at what has been claimed and to help you talk with your doctor or primary care physician here are a few peer-reviewed journal articles on studies to support your requests.

A review of all current studies on T4 + T3 medication published in The Journal of Clinical Endocrinology & Metabolism suggests:

-    "TSH level within the reference range is not a sufficiently optimal marker of adequate thyroid hormone replacement therapy in hypothyroid patients".

-    “Consider a personalized regimen of thyroid hormone replacement therapy in hypothyroid patients” using T3 + T4 as needed. (Biondi & Wartofsky,2012).

For those interested in natural thyroid medication, called desiccated thyroid extract  (DTE) or natural desiccated thyroid (NDT), these medications typically include a combination of T3 and T4 sourced from animals.  A study on hypothyroid people previously prescribed desiccated thyroid extract who were switched to levothyroxine (synthetic T4) reported they felt worse “despite adequate dosing based on serum TSH levels” (Hoang, et al., 2013).

Now that’s what I call the Buffy the Vampire Slayer roundhouse kick to the old, TSH is the best and only measure of thyroid function for the hypothyroid and Hashimoto’s, supporters. I’m hoping this belief goes up in dust one day!  

Dosing T3

Often I am asked to provide advice on dosages of medication. I am not a doctor so I do not provide advice on dosing medications.  Advice on medication must always be taken from a doctor and/or pharmacist. If you are listening to alternate advice on medication for yourself please always prioritise what a doctor or pharmacist has recommended.

However, when these questions are asked of me by doctors and pharmacist, I point to the following evidence for their research: 

-    When adding in T3, 50 µg of the patient’s T4 replacement dose may be replaced by 12.5 µg T3  (Wiersinga, 2001).

-    Bearing in mind T3 medication may be most safely titrated up from minimum starting dose of 5mcg testing every 4 - 6 weeks and based on results and signs and symptoms.

-    Additional doses of T3 may be most safely taken divided throughout the day rather than in one-morning dose. This is contrary to the method of dosing T4 once/day.

-    Always caution if the pulse rate increases over 90 beats/minute, blood pressure increases, rapid breathing, sensation of a tight chest and/or anxiety appear or increase, T3 medication should be stopped immediately and medical advice and intervention sought urgently.

Does this mean I am advocating if you feel well, healthy, happy and are symptom free on T4 medications you need to swap?  Nope.  

One size does not fit all when it comes to thyroid medication.

If you don’t feel as good as you want to:

1.   Request a thorough medical questioning on signs and symptoms you are experiencing and compare these with thyroid signs and symptoms. Check out my download on thyroid signs and symptoms for suggestions.

2.   Comprehensive laboratory testing of thyroid:

a) Baseline standard pathology testing:  TSH, Free T4, Free T3. 

b) Additional judgement if T3 is not providing relief anticipated: Reverse T3 (rT3) which is best compared with T3 levels tested at the same time.

The bottom line:

•       Testing TSH is not enough if you are still experiencing hypothyroidism symptoms.

•       T4 medication alone may not be the best option for all hypothyroid and Hashimoto’s patients.

•       It may be possible to match your thyroid medication to what you need to feel good.

In health and happy hormones,

Sonia x 

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References:

Biondi, B., & Wartofsky, L. (2012). Combination treatment with T4 and T3: toward personalized replacement therapy in hypothyroidism? The Journal of Clinical Endocrinology & Metabolism, 97(7), 2256-2271.  https://pdfs.semanticscholar.org/1f05/33af337382745a8e57b1c58f21c9cc082ee3.pdf

Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. (2013). Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. The Journal of Clinical Endocrinology & Metabolism, 98(5), 1982-1990.  https://pdfs.semanticscholar.org/8a02/5f13a5c7bd8992475c21e5ad93d802c8546f.pdf

Wiersinga, W. M. (2001). Thyroid hormone replacement therapy. Hormone Research in Paediatrics, 56(Suppl. 1), 74-81. https://www.ncbi.nlm.nih.gov/pubmed/11786691

Maca has been found to be effective in relieving the menopausal symptoms of hot flushes, night sweats, depression, irritability, headaches & lowered libido. 

If you’ve not tried Maca before it is a root of a plant used in South America to treat imbalances in female hormones and it tastes slightly sweet like butterscotch. 

In scientific study on 168 caucasian menopausal women Maca was found to be an effective natural alternative to hormone replacement therapy (HRT).  In the words of the researchers Maca was “superior to HRT in terms of all the additional benefits (…) not delivered by HRT programs or phyto-estrogenic preparations” for menopausal women.” 2.

Symptoms relief

Maca was found to reduced both frequency and severity of menopausal symptoms especially:

•          hot flushes and night sweating (with a significance of P<0.001)

•          nervousness

•          depression

•          headaches

•          loss of libido/interest in sex. 

As well as increasing ‘good’ cholesterol high density lipoproteins (HDL) (P<0.05).

Dosage matters

The study used 2 x 500 mg capsules twice daily with meals (total 2 g/day) during three and four months study periods. At the 2 month mark there was a distinctive reduction in severity of symptoms.

The study used a formulation of Maca called pre-gelatinized organic Maca so if it is those results you are after it’s that product you need to use.   

More Maca research 

Maca consistently shows its helpfulness in menopausal symptom relief in healthy peri-menopausal, early post-menopausal, and late post-menopausal women 1.

A high quality systematic review of Maca found it consistently caused a significant positive effect on sexual dysfunction or sexual desire in healthy menopausal women. 3.

Any bad news about Maca?

A systematic review of Maca highlighted:

1. As it is thought Maca increases oestrogen levels it should be avoided by women who have oestrogen sensitive conditions including cancers or a strong family history of these.

2. One argument for using Maca for the management of menopausal symptoms might be that it causes fewer adverse effects than conventional drug treatments, however, whilst none of the trials noted any adverse events among Maca users a specific study on adverse events has not been undertaken.

3. Only a small number of trials on Maca have been performed and with a relatively small number of people.

Here is a delicious recipe using Maca powder http://www.superfoodliving.com/maca-superfood-energy-bars

In health,

Sonia x

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References:

1. Lee, M. S., Shin, B. C., Yang, E. J., Lim, H. J., & Ernst, E. (2011). Maca (Lepidium meyenii) for treatment of menopausal symptoms: A systematic review. Maturitas, 70(3), 227-233. doi:10.1016/j.maturitas.2011.07.017

2. Meissner, H. O., Mscisz, A., Reich-Bilinska, H., Kapczynski, W., Mrozikiewicz, P., Bobkiewicz-Kozlowska, T., … & Barchia, I. (2006). Hormone-balancing effect of pre-gelatinized organic Maca (Lepidium peruvianum Chacon):(II) physiological and symptomatic responses of early-postmenopausal women to standardized doses of Maca in double blind, randomized, placebo-controlled, multi-centre clinical study. International Journal of Biomedical Science: IJBS, 2(4), 360.  Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614647/

3. Shin, B. C., Lee, M. S., Yang, E. J., Lim, H. S., & Ernst, E. (2010). Maca (L. meyenii) for improving sexual function: A systematic review. BMC Complementary and Alternative medicine, 10(1), 44. doi:10.1186/1472-6882-10-44

Have you heard of smudging? It’s the native American ritual of burning herbs, mainly white sage, to waft pungent herbal smoke in a space to cleanse it of any unwanted energies.

Sometimes balancing my passionate support of evidence-based solutions with the kookier cross-cultural traditions of herbalism makes me dive straight into a peer review journal article to see if I can find some kernel of fact in these woo-woo practices.

Guess what I found! A study published in the Journal of Ethnopharmacology proved medicinal smoke produced from burning wood and a mixture of smelly medicinal herbs caused a 94% reduction of bacterial counts in 60 minutes.

It seems as if there may be some basis in fact to why native Americans used to burn herbs to clear their air.  Whether or not my efforts create a fresh space remains to be seen …at least there will be less chance of catching a bug in my room.

If you are keen to ‘smudge’ your space please make sure you keep the smoke well away from your smoke detectors and sprinkler systems unless you want to add a water element to your ritual.

In health,

Sonia x

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References:

Braithwaite, M., Van Vuuren, S. F., & Viljoen, A. M. (2008). Validation of smoke inhalation therapy to treat microbial infections. Journal of ethnopharmacology, 119(3), 501-506.

One in five Australians will experience a mental illness this year and researchers have found what we eat, how often we move our body and how much sunshine we get may influence the risk of depression and anxiety.  Even suicide rates in children and teenagers have been linked to their lifestyle choices.

Australian tax payers spend $7.6 billion / year on mental health-related services. For many preventing and treating mental illness may not be as simple as diet and exercise but encouraging even small steps to build a healthier life are worthwhile exploring.

Convincing research suggests a diet rich in unprocessed vegetables, fruits, fish, meats, nuts and seeds will lower the chance of both depression and anxiety across all age groups from children to adults and the over 65s*.   

For those currently suffering from depression and anxiety specific nutrient-based supplements both in isolation and in combination have been shown to be effective for some people including omega-3 fatty acids, zinc, B vitamins, s-adenosyl methionine (SAMe) and n-acetyl cysteine (NAC)*.

Regular physical activity has been found repeatedly to be protective against the onset of both anxiety and depression as well as effective in treatment and management for some people.

In Australia any conversation about increasing unprotected time in the sun is controversial but it is important. Vitamin D made in our bodies from sunshine has been found to be protective against developing depression.  Unfortunately Australians are the most melanoma prone people in the world yet one third of us over 25 years of age is also Vitamin D deficient.  It’s time to talk about safe sun exposure! 

So this World Mental Health Day, Saturday 10 October, protect yourself against mental illness by getting accurate and tailored advice from a registered naturopath* and make sure you share with your doctor how you feel, what you are taking and doing – even if it is natural.

If you or someone you know is in crisis contact: Lifeline 13 11 14 (24 hour crisis hotline) Kids Help Line 1800 55 1800.

*Never stop or reduce medication without first speaking with your doctor or treating medical professional

In health,

Sonia x

Article originally published in InTouch Magazine

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References

Anglin, R. E., Samaan, Z., Walter, S. D., & McDonald, S. D. (2013). Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. The British Journal of Psychiatry, 202(2), 100-107.

Appleton, K. M., Rogers, P. J., & Ness, A. R. (2010). Updated systematic review and meta-analysis of the effects of n− 3 long-chain polyunsaturated fatty acids on depressed mood. The American Journal of Clinical Nutrition, ajcn-28313.

Australian Institute of Health and Wellness (2012). Mental Health Services in Australia. Retrieved from: https://mhsa.aihw.gov.au/home/

Daly, R. M., Gagnon, C., Lu, Z. X., Magliano, D. J., Dunstan, D. W., Sikaris, K. A., … & Shaw, J. E. (2012). Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: A national, population‐based study. Clinical Endocrinology, 77(1), 26-35.

Hosseinzadeh, M., Vafa, M., Esmaillzadeh, A., Feizi, A., Majdzadeh, R., Afshar, H., … & Adibi, P. (2015). Empirically derived dietary patterns in relation to psychological disorders. Public Health Nutrition, 1-14.

Kato, K. (2015). Differential Effects of Dietary Oils on Emotional and Cognitive Behaviors. PloS one, 10(3), e0120753.

Knight, A., Bryan, J., Wilson, C., Hodgson, J., & Murphy, K. (2015). A randomised controlled intervention trial evaluating the efficacy of a Mediterranean dietary pattern on cognitive function and psychological wellbeing in healthy older adults: the MedLey study. BMC Geriatrics, 15(1), 55.

Mental Health Australia (2015), Mental Health Begins with Me. Retrieved from: https://1010.org.au/about

Sarris, J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., … & Jacka, F. N. (2015). Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2(3), 271-274.

Australian Statistics:

Statistics quoted from 2007 National Survey of Mental Health and Wellbeing reported on Australian Institute of Health and Wellness.

The current obsession with shielding from all sun exposure may be dangerous* if you have a family history of any autoimmune condition.

Our bodies have been created with the ability to turn sunshine into Vitamin D and our immune systems need Vitamin D to work properly and well.

Vitamin D and Autoimmunity

In fact scientists have found people with low Vitamin D levels may have an increased risk of developing autoimmune thyroid diseases including Hashimoto’s thyroiditis and Graves’ disease as well as Systemic Lupus Erythematosus, Multiple Sclerosis, Rheumatoid Arthritis, Inflammatory Bowel Disease, and even Type 1 Diabetes.

If you have a family history of any type of autoimmune disease keeping your Vitamin D level healthy may be even more critical for you than the average person.  Investigate more than just mum, dad, grandma & grandad to find out if any aunts, uncles or cousins have an autoimmune conditions.

Vitamin D and Your Thyroid

Your thyroid gland is found in your neck just under where your Adam’s apple sits. 

Your thyroid gland has specific locations built for vitamin D called Vitamin D receptors.  New research has also found your thyroid might actually make Vitamin D itself!

Does SunBathing Mean My Vitamin D Level is Enough?

Unfortunately some people struggle to make Vitamin D from the sun.  Most at risk of this are those with autoimmune conditions, the overweight and obese and the elderly.

In fact in sunny Crete, an island in Greece, people with Hashimoto’s hypothyroidism were given a Vitamin D supplement and their thyroid antibody levels reduced.  This suggests even when you are in the sun regularly if you have an autoimmune thyroid condition you may need extra support from a supplement.

Should I Take a Pill?

I suggest to my clients to get their Vitamin D level tested at the end of summer with a simple blood test as one size does not fit all when it comes to sun exposure, supplementation and Vitamin D!

In health,

Sonia x

If you would like more information contact me on sonia@soniamcnaughton.com.

*    Always use your common sense in the sun.  Avoid looking directly into the sun, always protect your face and get out of the sun before you get burnt / turn pink.

*    If you have been given specific medical advice to avoid the sun you must follow the advice given by your treating medical professional.

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References

Boelaert, K., Newby, P. R., Simmonds, M. J., Holder, R. L., Carr-Smith, J. D., Heward, J. M., … & Franklyn, J. A. (2010). Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. The American Journal of Medicine, 123(2), 183-e1. doi:10.1016/j.amjmed.2009.06.030

Hong Zhang, Lingyun Liang, and Zhongjian Xie (2015) Low Vitamin D status is associated with increased thyrotropin-receptor antibody titer in Graves Disease. Endocrine Practice, 21(3), 258-263. doi:10.4158/EP14191.OR 

Mazokopakis, E. E., Papadomanolaki, M. G., Tsekouras, K. C., Evangelopoulos, A. D., Kotsiris, D. A., & Tzortzinis, A. A. (2015). Is vitamin D related to pathogenesis and treatment of Hashimoto’s thyroiditis. Hellenic Journal of Nuclear Medicine, 18(3), 222-227.