DR. IZABELLA WENTZ, PHARM D

Thyroid Pharmacist

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Need a Clue about Your Hashimoto's Root Cause

The Dose of Your Thyroid Medication Can Uncover Your Root Cause

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The fact that you’re not absorbing your medication properly could be a hint to the root cause of your thyroid condition.

A recent study published in the Journal of Clinical Endocrinology and Metabolism found that people with lactose intolerance needed higher doses of thyroid medication to get to an optimal TSH.

Dairy Can Be a Problem for Many People with Hashimoto’s

Cow’s milk contains a mix of sugar (lactose), protein (whey and casein) and fat (ghee). People can be sensitive to any of the three components of dairy. However, reactions to lactose and the dairy protein casein are the most common.

Some people with Hashimoto’s may be able to tolerate butter and clarified butter (known as ghee) because they contain very small amounts of dairy proteins, but even tiny amounts of butter caused me to have a reaction at the start of my Hashimoto’s journey.

I’ve written about the dairy protein associated reaction in Hashimoto’s before. Casein, and to a smaller degree, whey, which was a really big trigger for me, and going dairy free resolved three year’s of acid reflux in three days. You can read my Hashimoto’s and dairy story.

But I have not written about the impact of the dairy sugar lactose on Hashimoto’s, and even tiny amounts of it can have a profound impact on our ability to absorb thyroid medications. Worse of all, some thyroid medications actually contain lactose, inhibiting their own absorption!

An August 2014 study published in the Journal of Clinical Endocrinology and Metabolism by Cellini and colleagues found that lactose intolerance increased the requirement for thyroid medications.

The researchers found that the average person with Hashimoto’s required a median dose of 1.31 mcg/kg/day of levothyroxine to get to an average TSH right around 1 mU/L (that would be right around 90 mcg of levothyroxine for a 150 pound person), while a person with Hashimoto’s and lactose intolerance who continued to consume lactose needed a dose of 1.72 mcg/kg/day to reach the same goal (that would be like 116 mcg of levothyroxine for the same 150 pound person- big difference).

Furthermore, patients who had another gut disorder in addition to lactose intolerance required an even higher dose to get to their goal TSH 2.04 mcg/kg/day, or around 140 mcg for a 150-pound person, or 1.5 times the average dose.

2014 study by Asik and colleagues found that lactose intolerant Hashimoto’s patients who were taking levothyroxine showed a decrease in TSH after lactose restriction.

Whenever I see people whose TSH levels fluctuate and who have a hard time adjusting their medication up and down, I always suspect lactose intolerance unless the person is dairy free. I imagine the changes in TSH occur as a result of varying amounts of lactose a person may have on various days.

How Common Is Lactose Intolerance in Hashimoto’s?

Lactose intolerance rates in Caucasians have been reported to be between 7% to 20%, and much higher in people of Asian and African descent. Lactose intolerance can be genetic and permanent, or secondary to another condition and reversible. People with SIBO and Celiac disease are often lactose intolerant when first diagnosed, but once they address SIBO and Celiac disease, many times they find that their ability to tolerate lactose returns after 3-6 months.

A 2006 paper in the journal “Thyroid” described one woman with lactose intolerance and Hashimoto’s, and determined that lactose intolerance was a rare occurrence in causing malabsorption of thyroid medications, however, a newer study, done in 2014 study by Asik and colleagues tested 83 Hashimoto’s patients for lactose intolerance and found lactose intolerance in 75.9% of the patients!

38 of those patients were instructed to start a lactose-free diet for 8 weeks, and the researchers found that over this time, the patients’ TSH dropped, meaning, they were absorbing their thyroid medication better.

So This Lactose Thing Gets Even More Interesting…

For some lactose intolerant people, even tiny amounts of lactose that are found in thyroid medications can be an issue, resulting in impaired absorption of thyroid medications. Yes, thyroid medications could be sabotaging their own absorption if they contain even teeny amounts of lactose.

So if you are someone that can’t get his/her TSH into your sweet spot (TSH should be between 0.5-2 mU/L for most people to feel best) despite taking escalating doses of thyroid medications, consider lactose intolerance and the possibility that the lactose in your diet or even in your thyroid medication may be inhibiting its absorption.

Breaking Down Lactose

As my community is full of extremely smart and motivated people interested in finding solutions, someone is sure to ask… “What about taking Lactaid (a supplement that contains lactase, an enzyme that breaks down lactose) with your thyroid medications? Will that help with the absorption of the medication?

This is a really interesting question… In theory, it should work, but I have not tested that theory yet.  If any of you have had experience with taking Lactaid in conjunction with your lactose containing thyroid medications, I’d love for you to share your experience.

As far as diet, I have personally seen tremendous improvements in my health and the health of clients and readers on a dairy free diet, so this is something that I recommend across the board for people with Hashimoto’s.

Lactose Containing Thyroid Medications

  • Synthroid
  • Euthyrox
  • WP Thyroid
  • Nature-Throid
  • Most generic brands of levothyroxine
  • Some compounded medications- check with your pharmacist

Lactose Free Thyroid Medications

  • Tirosint
  • Armour Thyroid
  • Cytomel
  • Levoxyl
  • Some compounded medications- check with your pharmacist

Medication Tips

Of all of the T4 containing medications, Tirosint has the fewest fillers that may impair absorption, and this medication was specifically designed for this purpose. I’ve had many people on my Facebook page comment on how they felt much better on Tirosint compared to levothyroxine.

Of course, many people do not feel good on T4 only medication and that is beyond the scope of this post (this post is getting a wee bit long), but you can read more about that at which thyroid medication is best, if you are interested.

Of all of the T4/T3 combination medications, WP Thyroid has the fewest fillers that can impair absorption.

Armour thyroid does not contain lactose but contains corn-derived ingredients that can be problematic in corn sensitive individuals.

Other Factors Contributing to Medication Absorption

A 2012 Polish study by Ruchala and colleagues reported that thyroid patients who need more than 2 mcg/kg/day of levothyroxine with an increased TSH should be suspected of an absorption disorder.

This disorder could be caused by lactose intolerance, celiac disease, atrophic gastritis, H. pylori infection, inflammatory bowel disease, or parasite infection.

Interestingly, in my experience, many of these are also potential root causes of autoimmune thyroid disease and addressing some of these has helped people get into remission.

Read more in my article 6 Hashimoto’s Root Causes.

You can be tested for lactose intolerance, celiac disease, atrophic gastritis or inflammatory bowel disease by most conventional doctors.

For H. pylori and parasite infections, I only recommend working with these specific functional labs: BioHealth Lab, Diagnostic Solutions, and Genova. You would need to have a functional medicine doctor order those tests for your, or you can self-order them (scroll down for more info and resources).

Please note, another study found that 54% of people with hypothyroidism had SIBO, and one of the symptoms of SIBO is lactose intolerance. While this study found that treating SIBO helped the many digestive symptoms experienced by the patients, treatment of SIBO didn’t increase the absorption of thyroid medications.

I wonder if this is because the lactase enzymes do take a few months to regenerate if they do come back at all after treating SIBO, and the participants in the study were not placed on a lactose-restricted diet.

It’s important to find out if you have SIBO because this can be an underlying root cause of Hashimoto’s, and treating the SIBO can not only help your sugar digestive enzymes to regenerate but can also result in remission from Hashimoto’s in some cases. SIBO is a hot new topic in the gut world, so some more progressive doctors may be willing to test you for it. Otherwise, you can self-order a 3-hour lactulose breath test.

Low stomach acid can contribute to poor absorption as well. Some patients take their thyroid medications with a glass of water that includes squeezed lemon juice or a teaspoon of apple cider vinegar. I have had excellent results with using Betaine with Pepsin for low stomach acid.

Tips

Figure out your mcg/kg dose of thyroid medication. (Math refresher, take your current dosage of medication, then divide it by your weight in kilograms. To figure out your weight in kilograms, take your weight in pounds and divide it by 2.2.) Here’s a handy conversion chart if you take NDT medications to determine your approximate levothyroxine dose.

Key

If your TSH is around 1, and your dose is 1.31mcg/kg or less: your remaining triggers are likely to be outside of your gut.

If your TSH is >1, and your dose is 1.31mcg or higher: suspect that you have lactose intolerance.

If your dose is 2 mcg/kg or more: consider lactose intolerance + another gut disorder that could be inhibiting your medication absorption and potentially be the root cause of your condition.

**Please note, the TSH is not the only important thyroid test, just the one that was used in research. For more info on the top thyroid tests, read THIS article.

Consider testing for lactose intolerance or going lactose free. There’s a good possibility that if you have Hashimoto’s, you also have lactose intolerance. You can either put yourself on a lactose-free diet as a trial or have your doctor do a test for lactose intolerance. If you are someone that needs to see a test to take action (don’t worry, so was I), you can ask your doctor to order a hydrogen breath test for lactose intolerance or a lactose tolerance blood test for you.

Consider having functional medicine tests for the following root causes: SIBO (Small Intestinal Bacterial Overgrowth Breath Test (BioHealth)); parasites and other gut infections (GI-MAP, GI Pathogen Screen 401H, GI Effects). You can order these tests through your doctor or through the links provided.

PS. You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter for free by going to www.thyroidpharmacist.com/gift. You will also receive occasional updates about new research, resources, giveaways and helpful information.

For future updates, make sure to follow us on Facebook!

References

  1. Levoxyl Package Insert.
  2. Euthyrox Package Insert
  3. Lauritano, AC, et. al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2007 Nov;92(11):4180-4. Epub 2007 Aug 14.
  4. Ruchala M, et. al. The influence of lactose intolerance and other gastro-intestinal tract disorders on L-thyroxine absorption. Endokrynol Pol. 2012;63(4):318-23.
  5. Asik M, Gunes F, Binnetoglu E, Eroglu M, Bozkurt N, Sen H, Akbal E, Bakar C, Beyazit Y, Ukinc K. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine. 2014 Jun;46(2):279-84.
  6. Cellini M1, Santaguida MG, Gatto I, Virili C, Del Duca SC, Brusca N, Capriello S, Gargano L, Centanni M.Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J Clin Endocrinol Metab. 2014 Aug;99(8): E1454-8. doi: 10.1210/jc.2014-1217. Epub 2014 May 5. PMID: 24796930
  7. Muñoz-Torres M1, Varsavsky M, Alonso G. Lactose intolerance revealed by severe resistance to treatment with levothyroxine. Thyroid. 2006 Nov;16(11):1171-3.
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  1. I have been tested for dairy allergy on many levels, as well as lactose intolerance etc using Cyrex labs. I had NONE. Does that mean I am in the clear? I was only allergic to gluten and aramanth.
    Reply

    • Meredith- The gold standard or the most accurate test for uncovering reactive foods and individual food sensitivities is actually the Elimination Diet.

      It works better than trying a recommended dietary approach (i.e. gluten-free, Paleo, etc.) and even better than food sensitivity testing (which may be helpful in many cases but may not be affordable for many people). The elimination diet can work as a stand-alone or in symphony with food sensitivity testing.

      In contrast to other diets that simply exclude common problematic foods, an elimination diet is done to determine what particular food intolerances the individual may have. This allows us to tailor the diet to the person, not to the dietary philosophy! Going through an elimination diet will help you figure out your individual food triggers and your specific response to each trigger food. Here is an article you may find interesting! 🙂

      ELIMINATION DIET FOR HASHIMOTO’S
      https://thyroidpharmacist.com/articles/elimination-diet-for-hashimotos

      Reply

      • My name is Samantha and I am currently taking. 19 (yes 19) 200 mcg Synthroid and 50mcg of Chrome three times a day and my levels are crazy low. The doctor just keeps adding to the dosage. Something is definitely wrong and now I found out that I am lactose intolerant and insulin resistance. I’m going crazy, so tired, my hair is falling out and I just don’t know what to do ???

        Reply

          • Samantha – thank you for following this page. Have you have been prescribed thyroid replacement hormone but your thyroid levels are still not optimal and your doctor is convinced that Synthroid® (which is a T4 only hormone replacement) is the only replacement that you should try, remember, information is power! In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!
            This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
            https://thyroidpharmacist.com/checkout/?product_id=4702

        • Samantha – thank you for following this page. Most conventional physicians use the TSH test to determine if one has a thyroid disorder and to dose thyroid medications. However, this test can often times be misleading, as levels of circulating hormones may fluctuate at different times, such as in Hashimoto’s, where the person affected may fluctuate between highs and lows.

          Additionally, when scientists first set the “normal” ranges of TSH for healthy individuals, they inadvertently included elderly patients and others with compromised thyroid function in the calculations, leading to an overly lax reference range. This resulted in people with underactive thyroid hormones being told that their thyroid tests were “normal,” based on this skewed reference range.

          WHAT TO DO IF YOUR TSH IS NORMAL AND YOU ARE ANYTHING BUT
          https://thyroidpharmacist.com/articles/what-to-do-if-your-tsh-is-normal-and-you-are-anything-but/

          Here are the tests you need for diagnosis. Most endocrinologists don’t run them all so you will have to request them. Make sure to request a copy of your labs as well.

          TOP 6 THYROID TESTS FOR DIAGNOSIS
          https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

          Reply

    • Marcia- You may find more information in this group. When I was first diagnosed with Hashimoto’s, I felt so alone. My doctor didn’t think it was a big deal, and none of my friends or co-workers had it. It wasn’t until I started to research online that I found others who were going through the same thing.

      A couple of years after my diagnosis, I found Hashimoto’s 411, a closed Facebook group run by Alice Berry McDonnell. This group is amazing! It is comprised of an army of highly motivated, smart, supportive women and men (now 45,000+ strong), and each of them sharing ideas of what worked for them, things they were planning to try, and offering support to one another. The comfort I received from knowing that there were others going through the same challenges as I, was enormous.

      https://www.facebook.com/groups/hashimotos411/

      Ask questions. Post your thoughts. Scan the files. It is an absolutely amazing resource. Best of all it’s kept private from spammers.

      Reply

  3. How can I get my Dr to check me I’ve had many symptoms of this But my t4 is in limits, Ihave a lump under my arm for years giving me pain now
    Reply

  4. Have they only ever tested your T4 or have they run a full thyroid panel? IF not, then the dr needs to and if he/she wont, I would push to see an endocrinologist. I have been dealing w Thyroid issues since 2001 or at least known that was the problem.
    Reply

    • Cherie- 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 🙂

      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

  5. I hope that you see a dr. asap for that lump. PLEASE! I ignored a very small breast lump and ended up suffering w/ breast cancer. Don’t wait, GO NOW!
    Reply

  6. I really could not figure out my mcg/kg. I take 50 mcg of compounded slow-release t3 and 2 grains of Erfa Thyroid daily. Note the t4/t3 is different per grain in Canada. with slightly less t3/t4 hormones per grain. 2 grains of Erfa has 70 mcgs of T4 and 16 mcgs of T3 vs the USA of 76-T4 and 18-T3. So, I assume, I take 66 mcgs of T3 and 70mgs of T4 daily. If my dr decreases either med my t3 falls way below the reference range and I can hardly function. I am lactose-free and have been for years. I do not eat gluten or corn either. Any idea WHY I need such a high dose or can’t absorb my thyroid meds? Also, my TSH is always zero but I do have Hashimotos Thyroiditis and hardly any gland is left. Thanks for reading…
    Reply

  7. I would love to find a functional doctor who can prescribe I’m the Springfield MO area. My doctor gets very annoyed when I even mention anything I have read. So in need of help Ahmed a change. Thank you.
    Reply

  8. Great article Izabella.
    I’m going to send this to my grandparents who, in my opinion, may have hashimotos. They’ve gone the levothyroxine route via their doctor of course.
    Reply

  9. Hello Dr
    I have been suffering from underactive thyroid and Hashimoto. I was taking 175mcg levothyroxine long time which i was over loaded then eventually came down to 100mcg but drs warned me that i was still over!i have been advised to alternate the dosages to one day 100 next day 75. After trying it for a month or so i had Bad depression, slow brain function,hair loss and constipation so on..and im still on 100mcg. Recently im suffering from bad arthritic pain and have been diagnosed, tired all the time and depressed so I have no idea what to do?my drs are not listening!my test results three months aho was:tsh level 0.06mIU/L. 0.27 _ 4.20mIU/L.
    If you could advise me i would be grateful.
    Best regards
    TULAY
    Reply

  10. Person who is suffering from Hypothyroidism, which is also known as underactive thyroid disease, need additional supplements through medicines to stimulate and increase TSH.
    It is a very common disease which occurs due to the disorder of thyroid gland and it does not make enough thyroid hormone, which results to lead effects on the metabolism of human body. Similarly in Hyperthyroidism is just the reverse of Hypothyroidism, when thyroid produces more than normal. Izabella has share a great content with us.
    Reply

  11. This research is spot-on. Only a very small amount of thyroid medication puts my TSH in the optimal range. Not sure if it is a root cause, but I definitely have candida overgrowth AND Lyme disease. Early on I suspected that a year of oral steroids for a very suspicious shoulder injury to be the root cause. Turns out the shoulder issue was also a symptom of Lyme disease.
    Reply

  12. It seems All Thyroid, Armour, ERrfa, Acella – NDT, contains lactose, since this is a filler in the thyroid powder all brands use. It’s however not a large amount, and I don’t really think it matters.
    Reply

  13. I was put on Levothyroxine 50mcg and it ended up making my eyes feel like they were bulging from my head with severe eye pain. I have stopped taking it and my eyes feel better. My doctor thinks that I am bouncing between hypo and hyper. How do you deal with that? I am currently on nothing. I had another test done and the nurse called to say my vit D is still too low but since the doctor didn’t mention anything about the rest of the test it must be fine. Really? I called and asked for a copy of the results. This woman seems to be more about the numbers than the symptoms. I have been on the total elimination diet and on Sunday night I had a hamburger at home and it has hit me hard. I am so sick and it doesn’t feel like it’s going to get better anytime soon. Is there anything I can do to counteract it?
    Reply

  14. Oh Sharon! I can completely relate. I was thrilled that my hair stopped falling out and I wasn’t freezing cold for the first time in months, but I also had a dull headache and the eyes bugging out feeling on levothyroxine. I actually had an endocrinologist tell me that my numbers were better than his. Wishing you great success in finding someone who uses your symptoms to dig deeper to find your root cause!!!
    Reply

  15. Hello, I live in East Tennessee and am need of a very good and accurate medical doctor. I am hypo. Have had so many problems for years and no one seems to know what they are doing, and do not care to look for any thing else that might be causing me to be sick all of the time. I am so tired of being sick every day and need a doctor that knows what they are doing. Can you help me find one???
    Reply

  16. After going to several different doctors over a 3 year span, and them testing for thyroid and everything else but not finding anything, I decided I had turned into a hypochondriac but I did want to loose the extra weight I gained so I went to a nutritionist. After doing a very expensive blood panel he was the first person to tell me that I had a very serious thyroid problem. He put me on very specific vitamins according to what I needed and a very strict diet to figure out my triggers. If I eat like I’m supposed to I feel much better. My very highly regarded in the medical field Endocrinologist does not know anything about dieting for thyroid so I have learned to use a mix of the natural and medical fields. I try to stay away from sugar, dairy, and bread and eat lots of protein and fresh vegetables. When I do that and take my thyroid medicine I feel good. My fingernails are like they were before and my hair has stopped falling out.
    Reply

    • Cindy- That is great! Thank you so much for sharing! You may also be interested in checking out the Root Cause Recipe Portal. It is full of autoimmune paleo and paleo recipes. You’re able to organize weekly shopping lists, meal planning, etc. Hope you check it out.

      http://rootcauserecipes.com/

      Reply

  18. I guess I am in a no win situation. I have Hashimoto’s Tyroiditis AND Addison’s Disease, AND uncontrollable seizures! (along with arthritis, tendonitis, bursitis, tinnitis, osteopenia and osteoporosis – I’m sure there’s more, just can’t think of all of them right now) My thyroid is totally atrophied and the Addison’s is Primary Addison’s. I have to take something for my thyroid but shouldn’t for obvious reasons – adrenal and seizures! OH, I also have unspecified breathing problems – trouble getting a deep breath. So, Id really like to know what I’m supposed to do to at least try to somewhat improve my health!
    Reply

    • Kim- 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 🙂

      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

  20. I don’t have hashimoto (tested yearly sometimes twice a yr for the last 6 years) but I have hypothyroidism. I have a tsh .2 which is low and a low normal free t3 and low normal ft4 so dr wont raise dosage of nature throid. I also had problems like this with synthroid with the low ft3 ft4 and no high reverse t3. I was accidently overdosed on synthroid once and had the head mri s twice and they saw nothing wrong so…….my drs are stumped and I feel so hypo with fatigue….ANY IDEAS? do I go 400 miles south to dr dach or you have any ideas. I am post menopausal on bhrt progesterone 80 2x a day, estrogen 80/20 and testosterone…. I have hair loss and extreme fatigue

    Reply

    • JJ – thank you for following this page. I’m sorry to hear that you are struggling. 🙁

      Please, understand that due to liability issues, I am unable to answer specific medical questions.

      Did you know that if you live in the United States, the UK, Australia, Europe and most developed countries that add iodine to the salt supply and take thyroid medications, there’s a higher probability that you do have Hashimoto’s?

      Depending on the source, estimates are that between 90-95% of those with hypothyroidism have Hashimoto’s.

      But most doctors will never tell people that they have Hashimoto’s, or that their own immune system is attacking their thyroid. People are told that their “thyroid is sluggish”, and that these things happen with age and “Just take this pill, you’ll be fine.” I hope you check out these articles that I wrote.

      ARE YOU DOING EVERYTHING FOR YOUR THYROID BUT NOT YET WELL?
      https://thyroidpharmacist.com/articles/are-you-doing-everything-for-your-thyroid-but-not-yet-well/

      DO YOU HAVE HYPOTHYROIDISM OR HASHIMOTO’S OR BOTH?
      https://thyroidpharmacist.com/articles/do-you-have-hypothyroidism-or-hashimotos-or-both/

      Here are the tests you need for diagnosis. Most endocrinologists don’t run them all so you will have to request them. Make sure to request a copy of your labs as well.

      TOP 6 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  21. Dr. Wentz ,
    How do you calculate the proper dosage of Armour . My labs are within proper range but sometimes think that I could be reducing dosage . Have been AIP three months and following your protocols. Have been on 90 mg for 1 year now. Thanks…… Rebel with a cause

    Reply

  22. Hi Dr. Wendtz: beautiful and informative article. I have a question in relation to TSH. After a long time on NDT it seems it is common for TSH to go below range. After 3 months on synthroid (I switched to Synthroid as Ft4 levels were below range) TSH levels have not increased. Is this common? My Ft4 and FT3 are in range but quite low and I seriously don’t feel optimum as the doc keeps lowering the dosage- I don’t want to go any lower as I feel hypo.My question is – does TSH ever come back and is it necessary to?

    Reply

    • Karen – thank you for following this page.

      If you have been prescribed thyroid replacement hormone but your thyroid levels are still not optimal and your doctor is convinced that Synthroid® (which is a T4 only hormone replacement) is the only replacement that you should try, remember, information is power! In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!

      This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!

      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  23. Hi izabella. Great article. My Tsh levels and t3 seem fine but t4 was just within range. I know you can’t comment on individual cases due to liability but wondered if a low t4 when everything else is ok is something to be concerned about. I don’t feel good boy am told it’s chronic fatigue. My doctor and functional medicine practitioner said they are ok. I think I Remember reading one of your articles once that people said they feel better when t4 is at the top end of the range but can’t be sure (stupid brain fog)!’

    Reply

    • Angie – thank you for following this page. I’m sorry to hear that you are not feeling well. 🙁

      If you have been prescribed thyroid replacement hormone but your thyroid levels are still not optimal, and your doctor is convinced that Synthroid® (which is a T4 only hormone replacement) is the only replacement that you should try, remember, information is power! In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!

      This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!

      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  25. Dear Dr. Izabella Wentz,
    First of all I want to say that your work, dedication and help for all who suffer Hashimoto thyroiditis are really enormous and we all so grateful to you!
    Since I have discovered that I have Hashimoto (TPO 96 (≤34); free T3 4,87 (3,20-6,80); free T4 13.22 (12.00-22.00) and TSH 2,380 (0.330-4.200) entirely by myself last week after quite of time suspecting it due to some symptoms like: resistant to weight lost, lack of energy, low mood, anxiety and brain fog, I have written as much as a could for those days and I’m waiting for your book to be delivered form Amazon, after reading of which I’m planning to participate in your program “Hacking Hashimoto”. I have appointment with an endocrinologist for examination, but since I live in Bulgaria (Western Europe) and here there is no much choice of well-prepared doctors not from the “old school” as I may say, I cannot count on her advice regarding the treatment, I need your advice if I should start medication. As I’m aware of your liability regarding medical advices, I will not discuss dosages or etc. After reading your e book “Optimizing thyroid medications” I will only say that here we do not have compounded medications and I have decided to try taking NDT together with lactase enzyme (since I have DNA test for lactose intolerance).
    Finally the question is that it is difficult for me to decide if I have to go on hormone therapy now and after that to the “dive” more in the root cause (since I have done some things till now not knowing for the Hashimoto, but for my health, which means it is something else) or I should continue the searching till some moths later or TSH levels up? I.e. if the symptoms are not so worse as I have written for other women, but my TSH is going up (December 2016 was 1,62; march 2017 was 1,84 and now is 2,38), what is the best preferable way to go?
    Thank you so much in advance!
    Maria

    Reply

  26. I use Armour Thyroid 135 ml mg. My TSH is between .02 and .5. My weight in kilos varies from 77 to 90. What does this indicate in terms of root cause?

    Thank you so much!4x

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  27. I had severe lactose intolerance for several years. Stomach cramps, gas, diarrhea, etc. When I started taking Diatomaceous Earth every day, the intolerance disappeared. I’ve tested it several times just to be sure, but no symptoms at all from dairy now. It also seems to have helped my gluten sensitivity.

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  28. Hi Izabella,

    Firstly, thank you very much for the work you continue to do. Your book “Hashimoto’s Thyroiditis” is a huge help in sorting things out. I have underactive thyroid though I do not know if I have Hashimoto’s as none of my doctors over the years have been able to tell me. Also, I really appreciated your talk on the Adrenal Reset Summit.

    Regarding the presence of lactose in thyroid medications, I thought you might like to know for your Australian followers, that in Australia the two brands of T4 thyroxine medication are Eutroxsig and Oroxine. The package insert for Eutroxsig states that the inactive ingredients are starch-maize, lactose, dextrin, and magnesium stearate.

    I have problems with wheat and gluten and also with dairy products so I put myself on a gluten-free, dairy-free diet, but I think in my case it is the casein in the dairy and not the lactose, so just as well! I weigh 79kg and take one 75 mcg tablet per day. My latest blood work in June showed TSH 0.9 mIU/L (0.3-5.0), Free T4 15.2 pmol/L (10.0-20.0), and Free T3 3.4 pmol/L (2.3-5.7). For the last 3 months, I have been gradually getting off Somac PPI but I am struggling with reflux despite being extremely careful with what I eat. Since the beginning of the month, I have taken no Somac (I was on 80mg/day and got down to 20mg/day) but now I have been taking apple cider vinegar. I have had digestive problems all my life – I am now 70 – but having recently read information that I could be producing insufficient gastric acid instead of too much, I decided to give the apple cider vinegar a try. How long should it take before I see an improvement? Any suggestions would be most welcome.

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  30. Now I’m really confused! I did horrible on Armour, Lev & the other one that starts with an L…, sorry, can’t remember it all. Did great on Nature Thyroid for the first 3 months. Rapid weight loss, no more joint pain and my fatigue vanished, all temporary. Now what do I do? I do not tolerate dairy,

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  31. Good article. I always find your articles to be very informative. I’m a little confused about the ability to link dosage to the root cause. It’s my understanding that the dosage is a result of how much thyroid tissue is remaining to produce the hormone? I was once told that based on the dosage and my weight that about half my thyroid was still present and functioning normally.

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  32. You say WP Thyroid (westhroid pure) has lactose. Does that include Westhroid as well? It was not listed on either containing or not containing Lactose.

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  33. If I am currently doing a low FODMAP AIP diet and still feeling tired, brain foggy, low metabolism etc, could that tiny bit of lactose is the synthroid I take be the culprit? PS, I take 50 mcg synthroid and 25 mcg compounded slow release T3.
    Plus I have had and treated SIBO, gut infections and a sluggish gallbladder. I have the DH form of celiac, raynaunds, alopecia, HS, endometriosis and chronic migraine without aura and occasion hemipelgic migraine. TIA!

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  34. Thank you so much for posting that facebook group! I don’t like to use facebook much, its just so full of garbage, but that actually looks very useful. It’s nice to be able to talk to someone who understands this.

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  35. I’m not sure I fully understand the link between thyroid dosages and weight. But I am trying to. I think. I appreciate laying out the numbers. It helps me understand my diagnosis a bit more than I did previously. I just feel so behind on all of this.

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    • Angela – thank you for following this page. I understand your frustration! <3 When I was first diagnosed with Hashimoto’s, I felt so alone. My doctor didn’t think it was a big deal, and none of my friends or co-workers had it. It wasn’t until I started to research online that I found others who were going through the same thing.

      A couple of years after my diagnosis, I found Hashimoto’s 411, a closed Facebook group run by Alice Berry McDonnell. This group is amazing! It is comprised of an army of highly motivated, smart, supportive women and men (now 45,000+ strong), and each of them sharing ideas of what worked for them, things they were planning to try, and offering support to one another. The comfort I received from knowing that there were others going through the same challenges as I, was enormous. Here is the link to this group:

      https://www.facebook.com/groups/hashimotos411/

      Reply

  36. Have you ever heard that people who cannot tolerate increasing their thyroid medication are likely to have exposure to mold? My thyroid doctor found that 80% of his patients that could not tolerate an increase in their medications without side effects, were being exposed to mold and had mold in their body. I’ve run across another Dr (Dr. William Davis) who agrees and says it’s phenomenol that my doctor discovered this in thryoid patients. I did a test for mold in my home to prove there was no mold (and there wasnt much of anything) – but when I tested my car (A/C) and my RV (A/C) it was very high there! So he is probably correct – and no one ever talks about mold exposure and thyroid that I know of.

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