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Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

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Key Lab Tests to Find Your Root Cause

Finding Your Root Cause: Key Lab Tests

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

Dr. Izabella Wentz / November 1, 2018

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I receive so many questions from my readers about which labs to get for Hashimoto’s and where to get them. Figuring out which tests you should do can be overwhelming because there’s quite a bit of information out there, and there are multiple tests that can give us an idea of our current thyroid function, as well as triggers that can reveal why the thyroid may be malfunctioning. I wrote this article in hope that it serves as a starting point to help you determine which lab tests will be most helpful for uncovering your triggers.

I highly recommend working with a Functional Medicine clinician on your thyroid journey. Functional Medicine is a medical specialty dedicated to preventing, finding, and treating underlying causes of chronic illness, rather than merely treating disease symptoms.

If you have a practitioner who is willing to work with you, that practitioner can order most of the tests listed here. If you don’t have a practitioner like this on your team, I’ve spent some time reaching out to various lab companies to set up specialized channels that will allow you to self-order your own labs at a discount. I’ll specify which tests are usually covered on insurance if you have a willing practitioner that can bill insurance, which tests can be self-ordered and then submitted to insurance, and which ones are usually an out-of-pocket expense that you may need to save for. (You can use Health Savings Accounts for most.)

In this article, I will go over the tests that I think are critical for finding the root cause(s) of your Hashimoto’s condition, including:

  • Thyroid testing
  • Nutritional testing
  • Adrenal testing
  • Gut health testing
  • Infections testing
  • Genetic testing

Comprehensive Thyroid Testing

Establishing a baseline for your thyroid health and testing on a regular basis is a crucial first step in monitoring your health and understanding how possible “root cause” triggers may be affecting you. If you haven’t had any of the following thyroid tests done in the last three months, I recommend having them done as soon as possible.

TSH Test

TSH is a pituitary hormone that responds to low and high amounts of circulating thyroid hormone. This lab test reveals elevated TSH in people who have advanced Hashimoto’s or primary hypothyroidism. However, levels of thyroid hormone can fluctuate, so this test can potentially be misleading. It’s important to note that some people with Hashimoto’s and central hypothyroidism might have a normal reading when tested. People with Graves’ disease generally have a low TSH.

You can often predict an eventual rise in TSH decades before it happens. Usually, there’s an elevation in thyroid peroxidase antibodies (TPO Antibodies) and Thyroglobulin Antibodies (TGAb Antibodies) before TSH goes up. Those with Graves’ disease or thyroid cancer can have elevated thyroid antibodies, including TPO, TGAb, and TSH receptor antibodies.

The TSH level considered “normal” has been skewed for years because the original data collected included elderly patients and people with compromised thyroid function. Although there is an updated range, many doctors have been slow to join in. This is why I encourage you to work with a functional medicine doctor that will treat you and not just your labs.

Functional medicine practitioners have further defined that normal reference ranges should be between 1 and 2 μIU/mL, for a healthy person not taking thyroid medications. Anecdotally, most patients feel best with a TSH between 0.5-2 μIU/mL.

The TSH test can be useful in optimizing thyroid function by ensuring the TSH levels stay within the optimal reference range while implementing lifestyle interventions and medication dosage changes.

Free T4 and Free T3 Tests

Doctors usually measure total T3 and T4, which can be misleading because T3/T4 hormones are often bound to different types of proteins and aren’t available for proper use in our body. T4 (thyroxine) and T3 (triiodothyronine) are the two main thyroid hormones. T4 is known as prohormone and is 300 percent less biologically active than T3. T3 is the main biologically active thyroid hormone that runs our metabolism and gives us beautiful hair and energy.

Most of the commonly prescribed thyroid medications, like Synthroid (levothyroxine), only contain T4 and need to be converted to T3 in the body. In theory, the T4 to T3 conversion works as it’s supposed to, but in reality, we may not always convert T4 to T3. Free T4 and Free T3 tests reveal the levels of available and free thyroid hormones that interact with thyroid receptors.

Some clinicians may only test for free T4, but free T3 is also important to test, as some individuals may not be converting the T4 to the active T3 hormone properly. Thus, people may have normal T4 levels, but low T3 levels.

Thyroid peroxidase (TPO) and Thyroglobulin (Tg) Antibodies Tests

The TPOAb and TgAb tests measure the antibodies that are the markers of autoimmunity, letting us know that the immune system is launching an attack on the thyroid gland. Generally, the higher the thyroid peroxidase and thyroglobulin antibody numbers, the more aggressive the autoimmune attack is on the thyroid. However, not everyone will have antibodies. (Read more about how some people with Hashimoto’s may not have any antibodies.) While not everyone with Hashimoto’s will have these antibodies, those that do can use them as a gauge of how aggressive the attack is on their thyroid, and can track the antibodies over time to see if their current lifestyle interventions are working. A reduction in thyroid antibodies is usually an indication that their lifestyle changes are helping.

Thyroid Ultrasound

An ultrasound reveals what’s happening with your thyroid. It shows whether or not you have changes consistent with Hashimoto’s, which could be characterized by changes in blood flow to the thyroid gland, a shrunken or enlarged thyroid, or even a “rubbery” thyroid. If you have nodules present, then they need to be watched, and an ultrasound can spot tumors that need to be biopsied or examined. (You can read more about diagnosing thyroid cancer here.)

I recommend doing an ultrasound at least once in your lifetime. If there are issues that need monitoring, then it’s recommended to have the ultrasound done routinely, such as on an annual basis. If everything stays consistent with Hashimoto’s, you should probably have one done every five years. If you’re actively trying to regenerate thyroid tissue and are doing thyroid regeneration protocols (low level laser therapy is a promising approach), then every three months would suffice. An ultrasound will need to be ordered by your doctor.

Insurance Coverage/Interpretation: All of the thyroid tests listed above should be covered on insurance, if the practitioner who orders them is an MD, DO, PA or NP. You also have self-order options. I love Ulta Lab because you can self-order the labs, and later submit them to your insurance for reimbursement. (Be sure to check with your individual insurance to make sure they allow this.) This is also a wonderful option for people with a high deductible. While it’s always best to work with a practitioner for an interpretation of these labs (especially if you need a prescription), I’ve also written a comprehensive interpretation guide for your reference.

For a full guide on interpreting your thyroid tests, please see my article: Top 10 Thyroid Tests and How to Interpret Them.

Nutritional Testing

People with Hashimoto’s and thyroid disorders are at a greater risk for nutrient depletions.

Nutritional deficiencies are a two way street. Nutrient deficiencies (especially abnormal ferritin levels) can contribute to thyroid symptoms and can even trigger or exacerbate thyroid disease, while thyroid disorders can lead to nutrient depletions. Thyroid hormones determine our metabolism throughout the entire body. As such, the digestive tract is not spared, particularly the intestines. An insufficient amount of thyroid hormones makes nutrient extraction more difficult and less efficient, and can in itself lead to nutrient deficiencies.

Additionally, most people with thyroid conditions will have low stomach acid (hydrochloric acid, or HCl), which is necessary to break down protein. This can lead to a depletion of amino acids, B vitamins, iron, zinc, and other nutrients obtained from protein.

This is why I recommend testing for a few key nutrients that are vital to thyroid health.

Root Cause Nutrition Panel

The Root Cause Nutrition Panel tests for B12, ferritin, vitamin D, CMP and CBC levels:

  • B12 is often lacking in Hashimoto’s, and supplementation is needed because it can result in neuropathy, fatigue or problems with digestion. Optimal B12 levels should be between 700-900 pg/mL.
  • Ferritin is an important protein because it stores iron. If you’re deficient in it, then you probably have symptoms like hair loss, fatigue, and poor thyroid function. The optimal ferritin level for thyroid function is between 90-110 ng/mL.
  • Vitamin D is a major player in immune system balance. Hashimoto’s patients often have very low vitamin D ranges, and most of my clients who have gotten into remission have optimal levels of this nutrient. Vitamin D levels should be between 60 and 80 ng/L for optimal thyroid receptor and immune system function.
  • The CMP (complete metabolic panel) and CBC (complete blood count) will reveal your electrolyte levels, as well as how your cells are doing, how the liver and kidneys are functioning, and whether you are at risk for anemia. The results typically come back “normal” for most people with Hashimoto’s, but it’s important to have these done to rule out serious situations that may require urgent medical interventions.

Insurance Coverage/Interpretation: All of the nutrition tests listed above should be covered on insurance, if the practitioner who orders them is an MD, DO, PA or NP. You also have self-order options. I love Ulta Lab because you can self-order the labs, and later submit them to your insurance for reimbursement. (Be sure to check with your individual insurance to make sure they allow this.) This is also a wonderful option for people with a high deductible. While it’s always best to work with a practitioner for interpretation, I do have protocols for how to address these deficiencies in Hashimoto’s Protocol, as well as a comprehensive article on the most common nutrient deficiencies in those with Hashimoto’s.

Adrenal Testing

In my experience, 9 out of 10 people with Hashimoto’s will be affected by adrenal dysfunction. Treating hypothyroidism without treating the adrenals is one of the biggest reasons people continue to feel exhausted despite receiving treatment with thyroid hormones.

The adrenal glands release hormones such as cortisol and adrenaline. These “stress hormones” impact many important functions throughout the body. They help establish your stress tolerance, tame inflammation, regulate blood sugar and body fat, control potassium and sodium levels (which impact blood sugar), and influence sex drive and anti-aging.

I recommend getting an adrenal saliva test kit (like the Adrenal Stress Profile test by ZRT) for almost everyone with Hashimoto’s. Many symptoms of hypothyroidism actually overlap with poor adrenal function, so it’s important to get an understanding for how well your adrenals are working as you work to address your own root causes. You can read more about addressing adrenal dysfunction here. Along with stress management, I recommend Rootcology Adrenal Support to help restore proper adrenal function.

Insurance Coverage/Interpretation: Generally, adrenal saliva tests are not covered on most insurances because they are considered experimental. Furthermore, most conventional practitioners won’t have access to these tests, as they may not have accounts with the lab. I recommend working with a functional medicine practitioner for interpretation. I also have protocols based on test results in Hashimoto’s Protocol.

Gut Testing

Food Sensitivity Testing

Discovering and removing reactive foods changed my life. I felt incredibly better in just three days after removing dairy. It took me some time before I was willing to commit to this lifestyle change, but if I knew then what I know now, I would have made this diet change a lot sooner!

You can identify food sensitivities by noting your reactions after eating. When we eat foods we’re sensitive to, our body gets exhausted and depleted in energy. Reactive foods trigger an inflammatory response in the GI tract, leading to malabsorption of nutrients, and can also produce intestinal permeability whenever they are eaten.

Sometimes, our body will react to our food sensitivities quickly, and we may experience acid reflux, bloating, irritable bowel syndrome, palpitations, joint pain, anxiety, tingling or headaches.

It’s important to note that food sensitivities cause different types of reactions to foods than food allergies. Food allergies are immediate and often cause life-threatening reactions (picture the child who stops breathing after eating nuts), and are readily acknowledged and tested for by conventional medical doctors, especially allergists. These reactions are known as Type I hypersensitivity reactions and are governed by the IgE branch of the immune system.

However, food sensitivities are considered Type IV delayed hypersensitivity reactions governed by the IgG branch of the immune system—as the name implies, they do not occur right away. In fact, it can take up to four days for them to manifest, and this is one of the reasons why it’s so hard for most people to correlate food sensitivities with symptoms. For example, you may eat corn on Monday and have a panic attack on Wednesday!

Some of the most common symptoms of food sensitivities include post nasal drip, congestion, coughing, asthma, constipation, diarrhea, cramping, bloating, nausea, gas, acid reflux, burning, increased pulse, acne, eczema, itchiness, joint aches, pain, swelling, tingling, numbness, headache, dizziness, brain fog, anxiety, depression, fatigue, and insomnia.

In my experience, whenever we eat foods that flare up our IgG system, this also seems to flare up thyroid antibodies.

Most people will see a dramatic reduction in gut symptoms, brain symptoms, skin breakouts, and pain by eliminating the foods they are sensitive to. Some will also see a significant reduction in thyroid antibodies.

Eliminating a food for a few days (sometimes weeks) will give us a boost in overall health. When we reintroduce a reactive food, we should notice a return of previous symptoms, which will allow us to discern which foods are causing the reactions. This is known as the Elimination Diet.

One of the best ways to identify these delayed food sensitivities is with a blood test that identifies your personal sensitivities to a list of the most common ones. I recommend the 184 Food Allergy IgG test from Alletess or their 96 Food version.

Insurance Coverage/Interpretation: Generally, food sensitivity tests are not covered on most insurances because they are considered experimental, so your best bet is to either work with a practitioner who has access to them or self-order them. While it’s always best to work with a practitioner on interpretation, food sensitivity tests are pretty self explanatory for most people, and most can implement changes based on seeing their own results.

To learn more about testing for and addressing food sensitivities, read my article on food sensitivities and Hashimoto’s.

Testing for Small Intestinal Bacterial Overgrowth

Another possible culprit of your symptoms could be due to Small Intestinal Bacterial Overgrowth (SIBO). Studies have revealed that approximately 54 percent of people with hypothyroidism have SIBO, which can lead to intestinal permeability and contribute to a long list of digestive symptoms including acid reflux, belching, bloating, and irritable bowel syndrome.

Small intestinal overgrowth (SIBO) can be tested with the Small Intestinal Bacterial Overgrowth 3-Hr Lactulose-Genova Kit. Treating SIBO is a crucial component to your healing journey. In some cases, it can put your Hashimoto’s into remission and will help your sugar digestive enzymes regenerate, allowing you to better digest carbohydrates and greatly improve digestive function.

Treatment options vary and can include diets like the low FODMAPs diet, a low-carbohydrate diet, the GAPS diet or the Elemental diet. You can also take herbs like berberine, garlic, and oil of oregano, or even antibiotics like Rifaximin. Furthermore, you can start by removing dairy, as most people with SIBO are lactose intolerant. (You can read more about treatment options here.) Work with your practitioner or functional medical doctor to determine the right course for you.

Insurance Coverage/Interpretation: SIBO has become more accepted by mainstream medicine in recent years. SIBO tests may be covered on most insurances; however, you may have a hard time tracking down a practice that will order them, as not many practitioners are trained in SIBO testing, results and/or treatment. I recommend working with a practitioner to interpret results, and you can visit my article on SIBO for more information on protocols.

Comprehensive Gut Testing

A variety of gut infections and parasites have been implicated in triggering autoimmune thyroiditis, including Helicobacter pylori, Blastocystis hominis, and Yersinia enterocolitica. I’ve found that my clients and readers who do not get better with dietary and nutritional interventions alone, usually have one or more gut infections present exacerbating their condition. Finding and treating these infections often results in a significant reduction in symptoms, and can even lead to remission.

Additionally, most people with Hashimoto’s will have some degree of intestinal dysbiosis (an imbalance in the gut microbiome). Like food sensitivities and SIBO, dysbiosis can cause intestinal permeability and contribute to the autoimmune process and symptoms.

To identify these triggers, I recommend doing a comprehensive stool analysis, like the GI MAP (GI Microbial Assay Plus) – Diagnostic Solutions Kit. This test checks for bacteria, fungi, parasites and viruses in the gut. It also measures bacterial balance of normal flora and digestive markers, like elastase and secretory IgA, which provide further insight on overall digestive and intestinal health.

Insurance Coverage/Interpretation: Comprehensive stool tests may not be covered on insurance plans because they are still considered experimental. However, check with your insurance company, as some may pay for a portion of the test if it is ordered by an MD, DO, PA or NP. Please note, your practitioner has to have an account with each specific company to order the test, and most conventional doctors won’t have access to these types of stool tests. I recommend working with a practitioner to interpret results, and I also have many protocols in Hashimoto’s Protocol based on extensive stool tests.

Organic Acids Test (OAT)

The Organic Acids Test (OAT) by Great Plains Laboratory is a comprehensive urine test that measures markers for vitamin and mineral levels, oxidative stress, neurotransmitter levels, and oxalates. Many people with chronic illnesses excrete abnormal organic acids in their urine. These metabolic byproducts can be measured and can provide insight into hormone and vitamin metabolism, intestinal wall integrity, energy cycle function, neurotransmitter metabolites, and muscle function. I have found that this test can find many more cases of Candida as well as mold, and can also be useful for detecting key nutrient deficiencies such as vitamins B5 and B6, vitamin C, and CoQ10.

Insurance Coverage/Interpretation: Generally, the OAT test is not covered by insurance, so your best bet is to self-order it and work with a practitioner who can order it for you. I recommend working with a practitioner to interpret results.

Infection Testing

Infections are common in those with Hashimoto’s. Sometimes you’ll experience symptoms of the infection, and other times you won’t even know you have it. When I was on my healing journey, I discovered I had four infections! Once I healed them, I noticed a huge difference in my recovery progress.

Potential infections include Lyme disease, Epstein-Barr virus, and Cytomegalovirus. Infections often get the least amount of attention, yet I’ve found that finding an infection and treating it can lead to complete remission in Hashimoto’s.

Did you know? Infections often trigger Hashimoto’s through molecular mimicry. Molecular mimicry is a bit like it sounds. Bacterial or viral cells look a lot like the cells called self-antigens (antigens that originated in our bodies’ cells). In a way, they mimic the good guys. Our immune system gets in “fix it” mode and starts killing off the infection, but in the process, it starts killing off the cells that look a lot like the infection as well. This is a doorway for autoimmunity to usher itself in.

I always recommend my clients test for infections with the Root Cause Infections Panel because treating infections can alleviate a lot of symptoms, and can sometimes put Hashimoto’s into remission by identifying and then healing them. Treatment options vary between antibiotics and herbal protocols, or a mixture of both, as I note in my book Hashimoto’s Protocol. Your doctor can help you decide which is best. Read more about addressing infections here.

Insurance/Interpretation: All of the infection tests listed above should be covered on insurance, if the practitioner who orders them is an MD, DO, PA or NP. You also have self-order options. I love Ulta Lab because you can self-order the labs, and later submit them to your insurance for reimbursement. (Be sure to check with your individual insurance to make sure they allow this.) This is also a wonderful option for people with a high deductible. I recommend working with a practitioner to interpret results.

Genetic Testing

A variation to the MTHFR (Methylenetetrahydrofolate Reductase) gene is incredibly common. In fact, it’s present in up to 55 percent of the European population, is naturally occurring, and often has no negative health consequences—unless expressed.

The gene codes for the MTHFR enzyme, the enzyme that converts the amino acid homocysteine to methionine, a building block for proteins. As a result, individuals with a genetic variation and low activity of the MTHFR enzyme may present with elevated homocysteine levels, which have been associated with inflammation, heart disease, pregnancy complications, and even miscarriages. This has also been associated with higher rates of Down syndrome and birth defects in offspring, as well as other issues such as depression, an increased risk of blood clots, and a higher risk of certain cancers. Some of my clients with Hashimoto’s and the MTHFR gene variation have even reported having bigger blood clots during their menstrual cycles.

One of the key things to note is that this gene variation also prevents people from properly methylating, which is one of the body’s key detox processes that helps them get rid of toxins. Methylation impairment can result in an impaired ability to clear out certain toxins such as mercury and arsenic; and may lead to estrogen dominance. Symptoms like brain fog, multiple chemical sensitivities, depression, irritability and anxiety are related to impaired methylation, and as they are all too common symptoms in Hashimoto’s, I designed the MTHFR Pathways supplement by Rootcology to help support the methylation pathways.

Insurance/Interpretation: The MTHFR gene can be identified through a DNA analysis test, such as the one from Ulta Labs. I love Ulta Lab because you can self-order the labs, and later submit them to your insurance for reimbursement. (Be sure to check with your individual insurance to make sure they allow this.) This is also a wonderful option for people with a high deductible. You can also order a saliva test kit from 23andme.com, and upload your results to geneticgenie.org, which will then tell you if you have the genetic variation.

Next Steps

I hope these tests help you on your healing journey. I highly recommend working with a Functional Medicine doctor as you navigate testing, and I’ve put together a list of doctors to help you find someone in your own area. Download my free guides below!

If, for whatever reason, you are unable to get a doctor to order the tests for you, you always have the option of self-ordering the recommended tests online.

Testing can be costly, but it’s an important piece to your remission puzzle. I gave up shopping during my process to pay for certain tests. That was a big deal for me since shopping helped me cope with feeling so awful all the time. In the end, getting my Hashimoto’s into remission made the trade off so worth it! I hope ordering tests will help you uncover your root causes and feel better as well.

P.S. You can also download a free Thyroid Diet Guide, 10 thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter of my Root Cause book for free by signing up for my weekly newsletter. You will also receive occasional updates about new research, resources, giveaways, and helpful information.

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Filed Under: Autoimmune, Labs, Recovery Tagged With: Adrenal Saliva Testing, Autoimmune, Food Sensitivities, Genes, genetics, gut health, Hashimoto's, Hypothyroidism, Infections, Lab Tests, thyroid, Thyroid Hormone

Dr. Izabella Wentz

Dr. Izabella Wentz, PharmD, FASCP, is a clinical pharmacist, New York Times Bestselling Author, and a pioneering expert in lifestyle interventions for treating Hashimoto’s Thyroiditis.

She received a Doctor of Pharmacy degree from the Midwestern University Chicago College of Pharmacy at the age of 23, and has worked as a community pharmacist, a clinical consulting pharmacist, as well as a medication safety pharmacist. She is a Fellow of the American Society of Consultant Pharmacists and holds certifications in Medication Therapy Management and Advanced Diabetes Care.

Dr. Wentz has dedicated her career to addressing the root causes of autoimmune thyroid disease, after being diagnosed with Hashimoto’s Thyroiditis in 2009. As a patient advocate, researcher, clinician and educator, she is committed to raising awareness on how to overcome autoimmune thyroid disease.

Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Reader Interactions

Comments

  1. Lyndsy Byrd says

    November 2, 2018 at 7:11 AM

    Thank you for the information related to testing available outside of clinicians. It is not uncommon to run into doctors that are unwilling to listen to how their patients feel because their TSH is “in range.” I especially found the testing for adrenal issues helpful because sexual dysfunction is not uncommon, but people think it’s embarrassing so they don’t talk about it. I’m certainly going to talk about these tests with my PCP!

    Reply
    • Dr. Izabella says

      November 2, 2018 at 8:54 AM

      Lyndsy – you are very welcome! I am happy to hear you have found a practitioner! <3 Please keep me updated on your progress.

      Reply
  2. Margaret Winders says

    November 4, 2018 at 12:05 PM

    How can herpes affect Hashimottos disease!?

    Reply
    • Dr. Izabella says

      November 9, 2018 at 1:25 PM

      Margaret – thank you for reaching out. The herpes virus, and viruses in general, can definitely trigger Hashimoto’s. The first step I always recommend is supporting your adrenal glands, because herpes viruses can flare up in the presence of adrenal fatigue. The adrenals help balance our immune system, can expedite healing, and prevent the influx of disease. Next, I would recommend making sure you are getting enough nutrients to boost your immune system, including making sure your Vitamin D levels are optimal, as Vitamin D supports the immune system. Herpes viruses also thrive on arginine, and arginine rich foods are thought to trigger them. So, if you’re already gluten free, other things that can provide arginine to herpes viruses include nuts, chocolate, and spirulina. Lysine is a supplement that you can take to suppress arginine, and therefore suppress the herpes virus.
      I used to think that herpes viruses could not be eradicated, only suppressed, and I would often recommend antiviral medications to suppress them. These can be very helpful for symptoms where autoimmunity or fatigue are caused by a virus. You can speak to your doctor if you think that would be helpful for you. Additionally, some people have had success with eradicating herpes viruses with antiviral herbs, including Lomatium Dissectum from Barlow Herbal. You might find this article helpful as well.

      VIRUSES
      https://thyroidpharmacist.com/articles/viruses-may-trigger-hashimotos/

      Reply
  3. Ilene Mortenson says

    November 4, 2018 at 3:55 PM

    I have Hashimoto’s and have all the typical symptoms that go with it. I had my iron and ferritin checked thinking they might be low, but the ferritin came back at about 240. The doc wasn’t concerned at all and called it a “non-specific inflammation marker”. What tests should I be requesting as a follow up to that? Thank you, Ilene

    Reply
    • Dr. Izabella says

      November 7, 2018 at 11:31 AM

      Ilene – thank you for reaching out. Hashimoto’s and low iron do go together as leaky gut makes it hard to absorb iron from your diet. Normal ferritin levels for women are between 12 and 150 ng/mL. The optimal ferritin level for thyroid function is between 90-110 ng/ml. Here is an article you might find helpful.

      12 STRATEGIES TO OVERCOME HASHIMOTO’S FATIGUE https://thyroidpharmacist.com/articles/12-strategies-overcome-hashimotos-fatigue/

      Reply
  4. james whittlesey says

    November 5, 2018 at 12:57 PM

    I think you should mention that DCs (chiropractors) can order interpret these test and provide treatment options as well. I have been doing it for 20 years with lots of success. Many of the top educators in functional medicine are chiropractors. This is kind of a blind spot for many people.

    Reply
    • Dr. Izabella says

      November 6, 2018 at 11:29 AM

      James – Thanks for reaching out and sharing! I have created a database of clinicians on my website as a resource for my followers.
      Please consider submitting your information to our clinician database. Here is the link: https://thyroidpharmacistconsulting.myshopify.com/pages/submit-your-thyroid-clinician-recommendation

      Reply
  5. Kristin says

    November 6, 2018 at 10:38 AM

    Hello! Which of the MTHFR gene variants are you seeing in people with Hashimoto’s disease? Thank you!

    Reply
    • Dr. Izabella says

      November 6, 2018 at 11:37 AM

      Kristin – thank you for reaching out. These genes are not implicated in Hashimoto’s, but indirectly, having the MTHFR gene variation can help to create a perfect storm for Hashimoto’s. If you have the MTHFR gene variation, you’re more likely to accumulate heavy metals and toxins and have a more difficult time clearing them out, which, overtime, can trigger Hashimoto’s as well as cause symptoms related to liver congestion. For this reason, treating this gene variation may actually improve the symptoms you’re experiencing. Here are some resources you might find helpful:

      MTHFR
      https://thyroidpharmacist.com/articles/mthfr-hashimotos-and-nutrients/

      HOW SUPPORTING THE LIVER IS KEY TO RECOVERING FROM THYROID DISEASE
      https://thyroidpharmacist.com/articles/support-liver-recover-from-thyroid-disease/

      Reply
  6. Anna says

    November 6, 2018 at 1:15 PM

    Hello Dr Wentz !
    Your books and your knowledge is incredible!!
    I am debating which doctor to see : functional medicine doctor or internist with great knowledge of alternative and conventional medicine? Both of them I found through your list of Dr Right.
    Besides hypothyroidism I have hormonal disbalance . Thank you!!

    Reply
    • Dr. Izabella says

      November 7, 2018 at 11:19 AM

      Anna – you are very welcome! <3 Please keep me posted on your progress.

      Reply
  7. Jigmet says

    November 7, 2018 at 2:50 AM

    Hi I did a thyroid test last year and TSH was 3.05. My main issue is with the skin. I have cystic acne, hyperpigmentation and little malesma. Do you think I have thyroid problem and does thyroid has any role in my symptoms related to skin? And which are the tests you would recommend me?

    Reply
    • Dr. Izabella says

      November 7, 2018 at 11:17 AM

      Jigmet – thank you for reaching out and sharing your journey. Our skin is a window to our internal health. It is the body’s largest elimination organ, and also a canvas where toxicities, nutrient deficiencies, food sensitivities and hormonal imbalances can show up. Women with Hashimoto’s and autoimmune conditions are more likely to have dry, dull skin, rashes, hives, pre-menstrual acne and facial swelling, especially if their thyroid levels are not optimized and they are not absorbing vitamins and nutrients correctly.

      THE THYROID AND SKIN
      https://thyroidpharmacist.com/articles/the-thyroid-and-skin

      Reply
      • Jigmet says

        November 9, 2018 at 3:54 AM

        After reading your book I started taking pure encapsulations ( magnesium citrate) supplement hoping that it will clear my acne and it did. But when I stopped taking it after 3 months, the acne started coming back and I realised that after taking the supplement of magnesium I start getting malesma on my cheeks. I am not sure if that’s because of it or something else but now I have again started taking it and my acne is getting better again. I am not able to understand how long should I be on this supplement.

        Reply
        • Dr. Izabella says

          November 9, 2018 at 12:59 PM

          Jigmet – thank you for sharing. I wish I could give you more direct advice but, each person will react differently. I would advise you to ask your personal clinician who’s care you are under. <3

          Reply
      • Jigmet says

        November 9, 2018 at 9:11 AM

        I forgot to mention it that I really loved your book. All the information is so helpful and so easily explained. You did a great job???

        Reply
        • Dr. Izabella says

          November 9, 2018 at 12:50 PM

          Jigmet – thank you!

          Reply
  8. Jennifer says

    November 7, 2018 at 7:53 AM

    Hi Dr. Wentz! I was intrigued to hear about the Root Cause Panel at Ulta Lab Tests. If those root causes come back positive (I already know I have previous exposure Epstein Barr antibodies for example), can the doctors even treat the underlying virus(es) that may be hiding out in my system?
    Background: I am 47 y/o and currently ANA-positive, Hashimoto’s antibodies positive (2 types), anti-SSA/anti-SSB positive, low D, low B12, MTFHR negative. My TSH is 3.88 and my free T4 and free T3 are normal. I’m going to Johns Hopkins soon to discuss a possible Sjogren’s diagnosis. The rheumatologist here suggested I go on Plaquenil (I have concerns about eye damage; also saw medical study saying Plaquenil may not even work well on Sjogren’s as it does RA & lupus). Oddly 8 years ago I was positive for ANA, SSA, SSB and then was *negative* for 8 years and then I became positive again. I have had multiple flu-like viruses this year.

    Thanks for the great work you’re doing! I loved your book! 🙂

    Reply
    • Dr. Izabella says

      November 7, 2018 at 11:15 AM

      Jennifer – thank you for reaching out and sharing your journey. I am so sorry you are going through all of this. <3 Oftentimes patients will have additional autoimmune conditions. Most autoimmune conditions have common root causes, and a lot of times the things that are recommended for one autoimmune condition will help with others. Conditions that I have found to respond really well to the Hashimoto’s protocols have been rheumatoid arthritis, lupus, Celiac disease, irritable bowel syndrome, eczema, asthma, Graves’, premature ovarian failure, psoriasis, Alopecia Areata, and Sjogrens. I have also seen the protocols help with Fibromyalgia, chronic fatigue syndrome, PCOS, as well as Type 2 diabetes, Crohn’s, and Ulcerative colitis.
      We need to rebalance the immune system to prevent this. Sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
      Hashimoto’s Protocol
      http://amzn.to/2B5J1mq

      Hashimoto’s Root Cause
      http://amzn.to/2DoeC80

      Reply
  9. Cynthia w Haigh says

    November 11, 2018 at 5:03 PM

    Thank you for your recipes but sadly I will sub out all Pumpkin due to serious allergy. My body gave me a new lifestyle and I am continuing to improve it. Is Entameobae nuttii a pathogen or commensal? On vacation in St Thomas and not sure of spelling. God Bless you. Cindy

    Reply
    • Dr. Izabella says

      November 15, 2018 at 7:55 AM

      Cynthia – thank you for sharing! Enjoy your vacation and feel free to substitute where ever you need to! <3

      Reply
  10. Jenny says

    November 15, 2018 at 2:10 PM

    I feel like all of these test would be needed to start my healing journey but is there a good order to follow? I would like to prioritize my approach. Thank you for this wonderful information.

    Reply
    • Dr. Izabella says

      November 19, 2018 at 9:29 AM

      Jenny – thank you for reaching out. I recommend starting off with these thyroid function tests:

      ¨ TSH
      ¨ TPO Antibodies
      ¨ Thyroglobulin Antibodies
      ¨ Free T4
      ¨ Free T3
      ¨ Reverse T3 (optional)
      ¨ Thyroid Ultrasound (optional)

      It’s always best to speak to your functional medicine practitioner to evaluate your specific case, and whether you need more testing. Here is a research article which might help further:
      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply
  11. LAN LAN says

    November 15, 2018 at 8:30 PM

    Hello, I’m from China. After reading your book, I began to take supplements, exercise and rest every day. Looking forward to your future advanced treatment of this disease. I am currently in the early stage of Hashimoto’s thyroiditis. Domestic doctors say I don’t need to take medicine now, but rely on hormones. I am worried that I will become vulnerable in the future. Doctor, if my antibody can return to normal, will it not become hypothyroidism? Thank you

    Reply
    • Dr. Izabella says

      November 25, 2018 at 1:21 PM

      Lan – thank you for sharing you journey! Thyroid tissue can regenerate, but the rate at which it does is not always predictable. Thus, some are able to stop the autoimmune attack on their thyroid and regain normal thyroid function. Others can reduce the dose of medications, and others will need to stay on the medications indefinitely. I’m currently working on some protocols to help with tissue regeneration. Reversing Hashimoto’s means different things to different people. For some, it means a reduction in symptoms, and for others, it means a reduction in your antibodies. I had both. Here a few articles that might be helpful for you:

      IS IT POSSIBLE TO RECOVER THYROID FUNCTION IN HASHIMOTO’S
      https://thyroidpharmacist.com/articles/is-it-possible-to-recover-thyroid-function-in-hashimotos

      REVERSING AUTOIMMUNITY? AND THE PERFECT STORM
      https://thyroidpharmacist.com/articles/reversing-autoimmunity-and-the-perfect-storm/

      HASHIMOTO’S SELF CARE, GETTING AND STAYING IN REMISSION
      https://thyroidpharmacist.com/articles/hashimotos-self-care

      Reply
  12. Rachel says

    November 26, 2018 at 1:45 PM

    I just recently had a thyroid panel done. My thyroid peroxidase AB is flagged as high (13 points over the reference range) on my test results, but my doctor told me since my thyroid was fine that I should just focus on eliminating stress and possibly doing something like the Whole 30. She hadn’t actually told me my numbers. I started reading your book and realized I needed a point of reference, so I had my results sent over to me. My Free T4 and T3 are on the very bottom of the spectrum. I guess I’m confused and freaking out a little, since my doctor seemed to think it wasn’t a big deal, but her opinion seems contrary to what I’ve read so far in your book. Any help would be appreciated.

    Reply
    • Dr. Izabella says

      November 26, 2018 at 4:15 PM

      Rachel – thank you for reaching out. <3 I understand how hard this can be. Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. How much thyroid replacement therapy is needed is unique and different for each person, so it's important to work with a functional medicine practitioner or a doctor, who can closely monitor your dosage and your progress. Every six weeks is usually a good schedule for testing your thyroid hormones. Here is a research article which might help further:
      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply
  13. Maria Stephens says

    November 29, 2018 at 11:23 AM

    I have suffer for panic attack since a change my diet to less carbs and no sugars. My TSH is high almost 6 and every time I eat something my blood pressure goes high or low. I quit alcohol and take some medicine for Cándida albicans but instead of feeling better for those changes I feel worse. What do you recommend doctor? Thanks so much in advance for your answer.

    Reply
    • Dr. Izabella says

      December 3, 2018 at 7:43 AM

      Maria – thank you for sharing your journey with me. I am so sorry you are struggling with all of this. I often have people play around with their fat to protein to carb ratios to find what fits them best. Some people (especially if they’re more active) will benefit from more proteins. Others benefit from more fats, such as those with brain fog, pain, and depression. Some may even benefit from ketosis. Personally, for me, lower carbs, higher fats, and ketosis made me feel amazing for a couple of years until I hit a plateau and then needed to add back more carbs to feel my best. The bottom line is that you have to adjust the diet to your needs and your needs may change! Here is an article you might find helpful as well.

      Top 7 Hashimoto’s Food Myths
      https://thyroidpharmacist.com/articles/top-7-hashimotos-food-myths/

      Reply
  14. Maria Stephens says

    November 29, 2018 at 11:24 AM

    I forget to mention but can Xanax affect your healing process for the liver protocols?

    Reply
    • Dr. Izabella says

      December 3, 2018 at 7:39 AM

      Maria – thank you for reaching out. For questions about the protocols please email my team at info@thyroidpharmacist.com and they will be happy to help you. <3

      Reply
  15. monsie pickles says

    December 5, 2018 at 1:24 PM

    Hello Izabella
    At present I am in the middle of the elimination diet as I am very sick from leaky gut and IBS. I cannot find your elimination diet in my downloads. I started a month ago with some difficulties. I am doing better ??? now but I cannot find your elimination diet in my downloads…
    Thanks for all your information.
    monsie pickles mrs

    Reply
    • Dr. Izabella says

      December 7, 2018 at 6:03 PM

      Monsie – thank you for reaching out. Here is a link to the article I wrote on the Elimination diet.

      https://thyroidpharmacist.com/articles/elimination-diet-for-hashimotos

      Reply
  16. Mike L says

    January 12, 2019 at 2:40 AM

    I had a panic attack about 4 months again after 6 weeks of intense military training. This has led into a long and slow recovery process. I dealt with a strange anxiety feeling for the first three months, but that has subsided through breathing techniques, meditation and stress reduction. My symptoms currently are tension headaches (that last from 10mins to 3 hours), zapping and tingling sensations all over my body. I currently take 150mcg synthroid M-F and 175mcg Sat and Sun. I exercise regularly five to six days a week. Not sure if I should take a supplement to reduce this symptom or what. Any advice would be appreciated.

    Reply
  17. Mike L says

    January 12, 2019 at 2:41 AM

    My previous comment had the wrong email

    Reply
    • Dr. Izabella says

      January 15, 2019 at 11:44 AM

      Mike – thank you for reaching out and sharing your journey. <3 I am sorry to hear you are struggling with all of this. Anxiety symptoms are very common in people with thyroid disorders. Here are some resources I hope you find helpful.

      HASHIMOTO'S AND ANXIETY
      https://thyroidpharmacist.com/articles/hashimotos-and-anxiety/

      AUTOIMMUNE THYROID DISEASE AND ANXIETY
      https://thyroidpharmacist.com/articles/autoimmune-thyroid-disease-and-anxiety

      ARE YOU GOING CRAZY OR IS IT JUST YOUR THYROID
      https://thyroidpharmacist.com/articles/are-you-going-crazy-or-is-it-just-your-thyroid

      Reply
  18. Mary says

    January 27, 2019 at 8:41 AM

    Hi, I am a newly graduated Nurse and I am really interested in functional/preventative medicine. My Father (50yo) has Celiacs disease and has been on Synthroid for the past 15 years due to “Hypothyroidism”. He has never officially been diagnosed with, but I think theres a good chance he has Hashimotos Thyroiditis. He feels good, with no S/S, his basic labs are normal, but I think he could feel even better and live a longer healthy life if he got off of Synthroid and was able to manage his thyroid with his diet and lifestyle changes. Do you think it is possible for him to get off of Synthroid after being on it for so long? and if so…what would be the best approach to do that? His doctor only monitors his TSH, he never looks at the other functions of the thyroid. Thank you for your work in this field!

    Reply
    • Dr. Izabella says

      January 28, 2019 at 3:14 PM

      Mary – thank you for reaching out and sharing your dad’s journey! Congratulations on becoming a nurse! <3 Thyroid tissue can regenerate, but the rate at which it does is not always predictable. Thus, some are able to stop the autoimmune attack on their thyroid and regain normal thyroid function. Others can reduce the dose of medications, and others will need to stay on the medications indefinitely. I'm currently working on some protocols to help with tissue regeneration. Reversing Hashimoto's means different things to different people. For some, it means a reduction in symptoms, and for others, it means a reduction in your antibodies. I had both. Here a few articles that might be helpful for you:

      IS IT POSSIBLE TO RECOVER THYROID FUNCTION IN HASHIMOTO'S
      https://thyroidpharmacist.com/articles/is-it-possible-to-recover-thyroid-function-in-hashimotos

      REVERSING AUTOIMMUNITY? AND THE PERFECT STORM
      https://thyroidpharmacist.com/articles/reversing-autoimmunity-and-the-perfect-storm/

      HASHIMOTO’S SELF CARE, GETTING AND STAYING IN REMISSION
      https://thyroidpharmacist.com/articles/hashimotos-self-care

      In case you want to learn more, here are the links to my books:

      Hashimoto’s Protocol
      http://amzn.to/2B5J1mq

      Hashimoto’s Root Cause
      http://amzn.to/2DoeC80

      Reply
  19. Megan says

    March 27, 2019 at 3:38 PM

    I am getting more thyroid testing as well as other blood work. Is there a particular type of month for women that these tests should be done? I have heard 18-20 days into your cycle (with the cycle starting with menstruation)- do you have information on this? Thank you for your help!

    Reply
    • Dr. Izabella Wentz says

      April 4, 2019 at 11:33 AM

      Megan – thank you for reaching out. For testing what is most important is whether to take the medication before testing or not. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning). Here are a couple articles you might find helpful.

      HOW TO GET ACCURATE LAB TESTING WHEN TAKING MEDICATIONS
      https://thyroidpharmacist.com/articles/how-to-get-accurate-lab-tests-when-taking-thyroid-medications/

      TOP 11 THINGS YOU NEED TO KNOW ABOUT THYROID MEDICATIONS
      https://thyroidpharmacist.com/articles/top-11-things-you-need-to-know-about-thyroid-medications/

      Reply
  20. Lynda Delaney says

    June 11, 2019 at 2:00 AM

    I recently went to a Naturopath and she did a Thyroflex screen – have you ever heard of this? It was testing my muscle reflex in my arm via my middle finger – which I found rather strange and really not quite sure what the purpose was other than to tell me I have a Thyroid disorder, which I already know. My Reflex speed: 322 and should be between 50-100.

    Reply
    • Dr. Izabella says

      June 11, 2019 at 11:11 AM

      Lynda – thank you for sharing. I don’t feel comfortable with my knowledge of this to comment on it. I recommend that you do your research and discuss your questions and concerns with your practitioner. <3

      Reply
  21. B says

    July 23, 2019 at 8:04 PM

    Dr. Izabella ~ I love all the detailed information about the thyroid and especially the testing that should be done. This is such a common problem and I have never seen as much information about what to do about it. Thank you! It is a little difficult to find a doctor who will do this testing as I am sure you are aware. Do you see patients? Is it possible to get an appointment with you?

    Reply
    • Dr. Izabella says

      July 29, 2019 at 7:01 AM

      B – thank you for reaching out and sharing. I understand how hard it is to find a practitioner. <3 I do provide a limited number of consultations, however, my consultative schedule is all full at the moment. I have a 12 week online program called Hashimoto’s Self-Management Program that covers all of the strategies that I go through with my one-on-one clients, in a self-paced format, so that participants have access to all of the things I’ve learned about Hashimoto’s without having to schedule costly consults with me or another practitioner. The program is currently on sale for my Birthday celebration and is 50% off. I hope you will check it out. If you have any questions about the program you are welcome to email my team at info@thyroidpharmacist.com as well.

      Hashimoto’s Self-Management Program
      http://hackinghashimotos.com/

      Reply
  22. Lindsay says

    September 15, 2019 at 7:49 PM

    Hi, Dr. Izabella!
    Thank you for your podcast interviews and your books!
    Do you have any suggestions for ways to increase ferritin (mine was 52, and I see you’re recommending 90-110) without raising iron (mine was 133 and toward the higher end of the normal range listed)? I already eat paleo with beef and lamb (and occasionally a little liver) and am hesitant to supplement.
    Thanks!

    Reply
    • Dr. Izabella Wentz says

      September 18, 2019 at 6:54 AM

      Lindsay – thank you so much for your support! I am happy to hear you are enjoying my podcasts and books. <3 Hashimoto's and low iron do go together as leaky gut makes it hard to absorb iron from your diet. These are the ferritin levels from my book, page 83. Normal ferritin levels for women are between 12 and 150 ng/mL. The optimal ferritin level for thyroid function is between 90-110 ng/ml. To restore your iron levels, you can eat cooked liver twice per week or eat beef a few times per week. Vitamin C increases the absorption of iron, so taking a vitamin C tablet or vitamin C rich food such as cooked broccoli along with an iron-rich food is the best way to increase iron and ferritin levels. Creating an acidic stomach environment by taking a Betaine and Pepsin supplement with meals can be helpful as well.

      Here are some resources I hope you find helpful:

      Most Common Nutrient Deficiencies
      https://thyroidpharmacist.com/articles/most-common-nutrient-deficiencies-hashimotos/

      Betaine with Pepsin
      https://rootcology.com/collections/supplements/products/betaine-with-pepsin

      Reply
  23. Nicole Watson says

    September 30, 2019 at 2:46 PM

    Hello. Do you take patients remotely ? I have been working with an ND and I have followed your suggestions in Root Cause. I really appreciate you sharing all your amazing work with us. ❤️

    Reply
    • Dr. Izabella says

      October 2, 2019 at 6:54 AM

      Nicole – thank you for reaching out! <3 I do provide a limited number of consultations, however, my consultative schedule is all full at the moment. I have a 12 week online program called Hashimoto’s Self-Management Program, that covers all of the strategies that I go through with my one-on-one clients, in a self-paced format, so that participants have access to all of the things I’ve learned about Hashimoto’s without having to schedule costly consults with me or another practitioner. Here is the link to the program:

      Hashimoto’s Self-Management Program
      https://thyroidpharmacist.com/enroll-in-hashimotos-program/

      Reply
  24. Brittany says

    February 12, 2020 at 12:32 PM

    Thank you for all of the great advice!
    I am wondering if the root cause test for infections includes any tests for mycoplasma bacterium, or if this primarily tests for viruses. It looks very helpful – I would like to be tested for viral infections and have been looking into tests for mycoplasma bacteria as well.

    Reply
    • Dr. Izabella Wentz says

      February 17, 2020 at 6:34 AM

      Brittany – thank you for reaching out! <3 For question about the testing please email my team at info@thyroidpharmacist.com and they will be happy to help you!

      Reply
  25. Andrea Cheyann Boyer says

    April 7, 2021 at 5:54 PM

    I am looking to get a food sensitivity test, I have Hashimoto’s and have been following your protocol for 4 weeks now. I am still having bouts of hives randomly and can’t figure out what is making me break out.

    Reply
    • Dr. Izabella Wentz says

      April 8, 2021 at 8:00 AM

      Andrea – thank you for reaching out. ❤️ I’ve found that many Hashimoto’s patients also have the gut infection Blastocystis hominis, which has recently been connected to irritable bowel syndrome, hives AND Hashimoto’s. In the last few years, I’ve noticed that getting rid of the Blastocystis hominis infection can help people to get their Hashimoto’s into remission. Read more about it in my Blastocystis article: A

      COMMON ROOT CAUSE OF HASHIMOTO’S, HIVES AND IBS
      https://thyroidpharmacist.com/articles/the-common-root-cause-of-hashimotos-hives-and-ibs

      Reply

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.


Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.


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