Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

Need a Clue about Your Hashimoto's Root Cause

The Dose of Your Thyroid Medication Can Uncover Your Root Cause

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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Did you know that the fact that you’re not absorbing your medication properly, could be a hint to the root cause of your thyroid condition?

As a pharmacist trained in conventional, integrative, functional, and natural medicine, I have a deep respect for various healing modalities… including medications. However, my years of experience as a clinical consultant pharmacist have also taught me that medications are often used inappropriately.

I certainly see this all of the time with respect to thyroid medications. People with overt thyroid symptoms are denied thyroid medications because their “numbers are normal.” Other times, they’re given the wrong meds, or not enough of the right ones. While I often talk about various healing modalities that we can use to take back our health, for many of us with Hashimoto’s, thyroid hormone medications are also often a critical part of the healing journey.

One area that is often overlooked when dosing thyroid medications is the role that absorption plays in how well a person does on a particular medication, and how the other ingredients present in the thyroid medication affect absorption.

For example, many thyroid medications contain lactose, and we know that dairy intolerance is a common symptom for many people with Hashimoto’s. A recent study found that people with lactose intolerance needed higher doses of thyroid medication to get their thyroid stimulating hormone (TSH levels) within optimal ranges. For others, it could be due to an underlying infection; and yet for others, it could be due to the timing of your medications. If you’ve found that you have to keep increasing your thyroid medication dosage to get your hormones into normal ranges, this might be a clue to your root cause.

Read on to learn more about:

  • What factors affect thyroid medication absorption
  • Dairy/lactose issues and Hashimoto’s
  • Infections contributing to absorption issues
  • Drug, food and supplement interactions contributing to absorption issues
  • How to optimize your medication for better absorption

How Well Are You Absorbing Your Thyroid Medication?

Thyroid medications have a narrow therapeutic index (they are referred to as “Goldilocks” medications, as they have to be dosed “just right” to be effective and to prevent adverse effects). Therefore, if the absorption is inconsistent, you can sometimes get too much or too little. This can cause fluctuations between hyperthyroidism and hypothyroidism symptoms.

Hypo and Hyperthyroidism Symptoms

Several studies consisting of patients receiving levothyroxine (T4 medication) therapy, have shown that a large percentage of patients (40-48 percent) are over- or undertreated. One 2014 study found that, even with frequent dose adjustments and monitoring, 37 percent of people taking levothyroxine often still had TSH levels outside of the normal reference range. This is often a result of inconsistent absorption.

While everyone is a bit different, for the most part, many of my clients and readers feel best with a TSH between 0.5 and 2 μIU/mL. (For the purpose of this article, I will be focusing on optimizing TSH. However, please note that there are also the free hormone levels to consider, including free T4 and free T3, thyroid antibodies, as well as other imbalances/root causes that may contribute to symptoms).

I always say that optimizing a person’s thyroid medication is both an art and a science: so many factors can impact your medication’s effectiveness. I recommend finding a trusted functional practitioner who is able to titrate and prescribe the perfect dose and formulation (T4, T3, or a combination of both) for your particular thyroid health status.

Ideally, your practitioner should also be aware that certain factors, such as fillers in your medication, underlying infections, and low stomach acid, in addition to having acid reflux, food sensitivities, or digestive issues, or taking your medications with your morning cup of coffee, can potentially sabotage your medication’s absorption, and thus effectiveness.

Finding Your Optimal Dose

Your practitioner can help you determine your optimal medication dose, but there are some strategies to help you determine if the medication you are taking is being properly utilized. To determine how well you are absorbing your thyroid medications, you first need to find your appropriate control dose, or the dose at which your thyroid hormones fall within optimal ranges.

Researchers have found that the average person with Hashimoto’s requires a median dose of 1.31 mcg/kg/day of levothyroxine, to bring their average TSH levels to right around 1 mU/L (that would be right around 90 mcg of levothyroxine for a 150 pound person).

If you require more than that, this would be a clue that you may not be absorbing the medication properly.

First, you will need to figure out how many micrograms of levothyroxine you are currently taking for each kilogram you currently weigh, or your current “mcg/kg” dose of thyroid medication.

Math refresher: If you are taking levothyroxine, Synthroid, Levoxyl, Tirosint or another version of T4, take your current dosage of levothyroxine in micrograms, then divide it by your weight in kilograms.

For my American and British readers, to figure out your weight in kilograms, take your weight in pounds and divide it by 2.2.

If you are taking Armour, Nature-Throid, NP-Thyroid, compounded T4/T3 or another mix of T4 and T3, here’s a handy conversion chart if you take NDT medications to determine your equivalent levothyroxine dose.

Interpreting Your Results

If your TSH is around 1 mIU/L, and your “mcg/kg” dose is 1.31 mcg/kg or less, this is an indication that you are absorbing your thyroid medications well and your remaining triggers are likely to be outside of your gut.

If your TSH is >1 mlU/L, and your dose is 1.31 mcg or higher, you may have lactose intolerance at the root of your thyroid dose issues. The lactose in your diet (and potentially in the medications) may be an issue for you.

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

Let’s talk about each of these potential root causes.

Are You Taking Your Thyroid Meds Correctly?

If you find that your medication dose is outside of range of the control dose (or your optimal dose as determined by the formula above), the first question to ask yourself is, are you taking your medication correctly?

Most thyroid medications (with the exception of Tirosint and Tirosint-SOL) should always be taken on an empty stomach, at least 30 minutes before your first meal of the day. (Some people may even need to wait 1-2 hours if they have additional gut issues.)

Medications should be consumed with a full glass of water and spaced out from other medications or supplements, by at least one hour.

Calcium, iron, antacids, and cholesterol-lowering medications have all been shown to interfere with thyroid medication absorption and are often recommended to be taken at least four hours away from thyroid medications.

There are also certain foods to avoid within one hour of taking thyroid medication, including coffee, soy, grapefruit juice, cottonseed meal, walnuts, and dietary fiber.

If you are following these guidelines, are dairy-free and still find yourself having to increase your medication dose, an absorption issue related to a filler in your thyroid medication (such as lactose) might be something to consider.

Thyroid Medication Fillers

The inactive ingredients (fillers) within your given hormone medication need to be considered, as those can sometimes impact how your body will respond to your medication, and many of my clients experience sensitivities to the many fillers found in their T4 and NDT medications. (These have also been shown to affect the absorption rate and effectiveness of the very medication meant to help the thyroid!)

If you were to check the ingredient information listed for most thyroid medications, you’ll find a number of inactive ingredients. These may be used as bulking agents to stabilize the tablets, as preservatives, as coloring agents, or as an aid in manufacturing in some way.

Disintegrants (some examples being starches and cellulose) are added to help promote the breakup of the tablet into smaller pieces when the tablet hits an aqueous environment (such as when you drink water with your meds, or when your meds touch the saliva in your mouth). This promotes a more rapid release of the medication.

Synthroid contains lactose as well as corn starch, confectioners’ sugar, magnesium stearate, talc, povidone, and color additives. As another example, Levoxyl contains five inactive ingredients, including an anti-caking agent, a filler, a rapid disintegrant, an antacid, and a flow agent (along with two dyes made from coal tar).

Here’s a list of some of the most common inactive ingredients that you might find in your thyroid medication. A sensitivity to one or more of the ingredients can potentially interfere with medication absorption.

  • Lactose monohydrate
  • Modified wheat starch (gluten)
  • Confectioners’ sugar (may contain corn starch)
  • Acacia
  • Corn starch
  • Dyes
  • Sucrose
  • Talc
  • Microcrystalline cellulose
  • Calcium stearate
  • Mineral oil
  • Inulin
  • Medium chain triglycerides
  • Dextrose
  • Sodium starch glycolate
  • Opadry white
  • Colloidal silicon dioxide
  • Dicalcium phosphate
  • Magnesium stearate
  • Croscarmellose sodium
  • Stearic Acid, Opadry II 85F19316 Clear
  • And many more…

While these ingredients are only present in small amounts, any one of these can cause an adverse reaction in a sensitive individual, and some fillers are more reactive than others.

According to the package insert for Unithroid, “Hypersensitivity reactions to inactive ingredients have occurred in patients treated with thyroid hormone products. These include urticaria, pruritus, skin rash, flushing, angioedema, various gastrointestinal symptoms (abdominal pain, nausea, vomiting and diarrhea), fever, arthralgia, serum sickness and wheezing. Hypersensitivity to levothyroxine itself is not known to occur.”

In addition to hypersensitivity reactions like the ones listed above, studies have found that inactive fillers and formulations can lead to potential issues with the absorption of thyroid medications, lactose being the most well described reactive ingredient in the research.

For some people with lactose intolerance, the amount of lactose in thyroid medications may not be enough to impair absorption (a dairy research article mentions that even a full glass of milk may be tolerated by many people with lactose intolerance). However, for individuals that are more sensitive, even the small amounts of lactose (and potentially other inactive fillers) can be an issue.

As an individual can be reactive to just about anything, I generally believe that the fewer filler ingredients are present in our medications, the less likely we are to react, and the more likely we are to absorb them.

For this article, I’m going to focus on lactose, as this ingredient has the most research behind it in causing medication absorption issues in hypothyroidism. However, please note that any inactive ingredient could be a potential issue.

The Dairy Problem with Hashimoto’s

Dairy is a common food sensitivity for those 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.

Like many people with Hashimoto’s, I became sensitive to casein and whey, and going dairy free resolved three years of acid reflux in just three days. (Read more about my dairy sensitivity here. These days I am no longer dairy sensitive, and will share my protocols for reversing this in future newsletters).

That said, the dairy sugar lactose is a common intolerance in Hashimoto’s as well, and during pharmacy school, I learned that even tiny amounts of it in our medications, can have a profound impact on our ability to absorb them if we happen to have a high degree of lactose intolerance. One important service provided by compounding pharmacists is recreating hypoallergenic versions of commercially available medications and making them free of reactive fillers, for sensitive patients.

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.

Remember that I had you calculate your mcg/kg dose of levothyroxine at the beginning of this article? This number can help you determine if you are absorbing your medications correctly.

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 — a 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 level of 2.04 mcg/kg/day, or around 140 mcg for a 150 pound person (1.5 times the average dose).

Whenever I see people whose TSH levels fluctuate and who have a hard time adjusting their medication up and down, who are still eating dairy, I always recommend the dairy-free diet as a first step. 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 percent and 20 percent, and much higher in people of Asian, African, Arab, Jewish, Greek, and Italian descent. (It is estimated that over 65 percent of the world has some degree of lactose intolerance.) I believe that various health conditions can also contribute to lactose intolerance.

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 three to six months. (We’ll discuss testing for lactose intolerance further on in this article.)

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 more recent study in 2014 by Asik and colleagues tested 83 Hashimoto’s patients for lactose intolerance and found lactose intolerance in 75.9 percent of the patients!

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

So, if you are someone that can’t get your TSH into your sweet spot (TSH should be between 0.5-2 μIU/mL for most people to feel their 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 (for those particularly sensitive) may be inhibiting its absorption.

I suggest checking your thyroid medication for lactose as an added ingredient and talking with your practitioner about switching to a lactose-free option.

Lactose-Containing Thyroid Medications

  • Synthroid
  • Euthyrox
  • Unithroid
  • Armour Thyroid*
  • WP Thyroid*
  • Nature-Throid*
  • NP Thyroid*
  • Most generic brands of levothyroxine – check with your pharmacist
  • Most compounded medications – check with your pharmacist

*Most NDT medications don’t add lactose as a filler. However, they do use lactose in the manufacturing process, so there may be very small amounts of lactose in the tablet. Also please note, at the time of writing this article, NP Thyroid, Nature-Throid & WP-Thyroid were recalling certain lots of medication due to potency issues.

I generally update the articles on this website every 1-2 years, and as the formulations and availability of various generic levothyroxine brands can change often, please consult with your pharmacist to ensure that you have the most up-to date and correct information.

Lactose-Free Thyroid Medications

  • Tirosint
  • Tirosint SOL
  • Cytomel
  • Levoxyl
  • Some compounded medications, check with your pharmacist
  • Some generic brands of levothyroxine, check with your pharmacist

I generally update the articles on this website every 1-2 years, and as the formulations and availability of various generic levothyroxine brands can change often, please consult with your pharmacist to ensure that you have the most up-to date and correct information.

Of all of the T4-containing medications, Tirosint and Tirosint SOL have the fewest fillers that may impair absorption, and these two medications were specifically designed for this purpose. I’ve had many clients, readers and people on my Facebook page comment on how they felt much better on Tirosint as compared to other levothyroxine medications.

Tirosint contains levothyroxine sodium dissolved in gelatin, glycerin and water. It came to the United States in 2017. The gel caps are free of inactive filler ingredients such as gluten, lactose, dyes, and preservatives that might cause tolerability or absorption issues.

Tirosint-SOL is available in liquid single-dose ampules and only contains two inactive ingredients (glycerol and water).

Of course, many people do not feel good on T4-only medication and that is beyond the scope of this post, but you can read more about that in my article Which Thyroid Medication is Best.

Of all of the T4/T3 combination medications, WP Thyroid contains the fewest fillers that can impair absorption. The inactive ingredients are inulin derived from chicory root and medium chain triglycerides derived from coconut.

Can Taking a Lactase Supplement Help?

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 — did it help you feel better? Did it help normalize your TSH?

In recent years, I’ve been super excited to hear from researchers who want to collaborate on studies with me, and while I can’t say yes to every opportunity, this would also be a great research study for any of the researchers following my work. 😉 (Please reach out to my team at info@thyroidpharmacist.com to make it happen!)

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 wholeheartedly recommend across the board for people with Hashimoto’s.

Other Factors Contributing to Medication Absorption Issues

If lactose intolerance doesn’t seem to be an issue for you, or if you are taking the lactose intolerance dosage and still not absorbing your medications well, this would indicate that something else is going on…

Again, are you taking your medication correctly, away from food, coffee, and other supplements or medications?

Are your medications free of dairy, gluten or other fillers that are problematic for you and may be preventing proper absorption?

If you answered yes… it might be time to dig deeper to look for an infection that could be inhibiting proper medication absorption in your gut.

As I mentioned earlier, if your dose is 2 mcg/kg or more, consider lactose intolerance along with another gut disorder that could be inhibiting your medication absorption and potentially be the root cause of your condition.

Other factors besides lactose intolerance that can affect absorption include celiac disease, atrophic gastritis, H. pylori infections, Blasto, Giardia, inflammatory bowel disease, and various parasitic infections. When we have gut bugs, they can make us super sensitive to EVERYTHING (even “healthy” things that are good for us).

You may want to consider having functional medicine tests for the following root causes: SIBO (Small Intestinal Bacterial Overgrowth 2-Hr Lactulose-Genova); parasites and other gut infections (GI-MAP, GI Effects Comprehensive Stool Analysis). You can order these tests through your doctor or through the links provided.

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.)

Testing is available through most conventional doctors for celiac disease, atrophic gastritis (often caused by H. pylori), or inflammatory bowel disease. (I hope to share an IBD protocol I used with a family member to reverse ulcerative colitis soon.)

For H. pylori, Giardia, and other parasitic infections, a functional medicine doctor can order tests for you, or you can self-order them through the links provided further on in this article.

Please note, another study found that 54 percent 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.

Regardless, 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 has become a hot topic in the gut world, so some more progressive doctors may be willing to test you for it. Otherwise, you can self-order a 2-hour Small Intestinal Bacterial Overgrowth lactulose breath test.

Low stomach acid (which is very common in Hashimoto’s) can contribute to poor absorption of many things, including thyroid medications. 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 personally had excellent results with using Betaine with Pepsin to support stomach acid.

The Takeaway

Finding the right thyroid medication and the right dosage, are crucial parts of getting your thyroid numbers within optimal ranges and feeling better with Hashimoto’s. This may require some level of experimentation, and being your own Root Cause detective to determine if there are any factors that are prohibiting you from absorbing your thyroid medications properly — such as added ingredients, underlying infections, or gut issues.

Because such a large group of people with Hashimoto’s have a sensitivity to dairy, I always recommend looking at lactose intolerance as a possible culprit when medications aren’t being properly absorbed. Many times, removing dairy from both diet and medication can result in more stable thyroid hormones and a relief from many symptoms of Hashimoto’s, including acid reflux, fatigue, joint pain, and skin issues (among others!).

I highly recommend finding a like-minded physician who can help you determine the right medication and dosage for you.

If you would like more guidance on uncovering your own root cause(s) and triggers, please read my books Hashimoto’s: The Root Cause, and Hashimoto’s Protocol. In them, you’ll find a step-by-step guide to getting yourself into remission and taking your life back.

I hope this information helps you on your journey to feeling your best!

P.S. To help you on your journey, you can download a free Thyroid Diet Guide, 10 thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter of my Hashimoto’s: The 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.

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

References

  1. 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.
  2. 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.
  3. Asik M, Gunes F, Binnetoglu E, Eroglu M, Bozkurt N, Sen H, et al. Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance. Endocrine. 2014 Jun;46(2):279-84.
  4. Cellini M, Santaguida MG, Gatto I, Virili C, Del Duca SC, Brusca N, et al. 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
  5. Muñoz-Torres M, Varsavsky M, Alonso G. Lactose intolerance revealed by severe resistance to treatment with levothyroxine. Thyroid. 2006 Nov;16(11):1171-3.
  6. Lactose Intolerance. U.S. National Library of Medicine website. https://ghr.nlm.nih.gov/condition/lactose-intolerance#statistics Accessed August 25, 2020.
  7. Armour Thyroid Product Prescribing Information. https://media.allergan.com/actavis/actavis/media/allergan-pdf-documents/product-prescribing/06-2018-Armour-Thyroid-PI-final.pdf. Published February 2020. Accessed September 2020.
  8. NP-Thyroid Prescribing Information. https://npthyroid.com/wp-content/uploads/2020/02/NP-Thyroid-flat-PI-10-15-19A-FPO.pdf. Published June 2018. Accessed September 2020.
  9. Tirosint Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021924s013lbl.pdf. Published December 2017. Accessed September 2020.
  10. Tirosint SOL Prescribing Information. Accessed September 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/206977s000lbl.pdf
  11. Cytomel Prescribing Information. http://labeling.pfizer.com/showlabeling.aspx?id=703. Published July 2019. Accessed September 2020.
  12. Levoxyl Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021301s026lbl.pdf. Published October 2007. Accessed September 2020.
  13. Unithroid Prescribing Information. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=07562e72-7eaa-4ce6-94f0-e08814787e50&type=display#section-13. Revised June 2019. Accessed September 2020.
  14. RLC Labs, Inc., Issues Voluntary Nationwide Recall of All Lots of Nature-Throid® and WP Thyroid® with Current Expiry Due to Sub Potency. US Food and Drug Administration website. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/rlc-labs-inc-issues-voluntary-nationwide-recall-all-lots-nature-throidr-and-wp-thyroidr-current. Published September 3, 2020. Accessed September 21, 2020.
  15. Acella Pharmaceuticals, LLC Issues Voluntary Nationwide Recall of Certain Lots of NP Thyroid® (Thyroid Tablets, USP) Due to Super Potency. US Food and Drug Administration website. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/acella-pharmaceuticals-llc-issues-voluntary-nationwide-recall-certain-lots-np-thyroidr-thyroid. Published May 22, 2020. Accessed September 21, 2020.
  16. Lactose Intolerance: Health Authorities’ Recommendations. Dairy Nutrition website. https://www.dairynutrition.ca/scientific-evidence/lactose-intolerance-and-milk-allergy/lactose-intolerance-health-authorities-recommendations. Accessed September 21, 2020.
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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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Comments

  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

  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

    Reply

  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.

    Reply

  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.

    Reply

  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,

    Reply

  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.

    Reply

  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.

    Reply

  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!

    Reply

  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.

    Reply

  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.

    Reply

    • 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.

    Reply

  38. Dr.Izabella, thank you so much for the information that you give.
    I have problems with protein digestion (whey and casein) and any protein ( in meat, in fish, in dairy products, vegetable protein too) but No problem with lactose. And I have Leaky gut. So can someone with these problems drink probiotics with Lacto and bifidobacteria?
    Sincerely, Kseniya.

    Reply

  39. Hi. What a great article. I am at my wits end here and the amount of info is overwhelming. I take levothyroxine 50micro gram for almost a year now and have hashimotos. It has stabilised my tsh, t3,t4 but my antibodies are over the top. The doc says he can do nothing about them. I have read a lot and its all spinning round my head. What can I do? I tried a nutritionist to no avail. I have a full on job, eat 3 meals and two ‘snacks’ daily. get hungry at night a bit. go to bed too late. eat organic and a fairly ok diet but still have high cholesterol (on 10mg meds now and its under control) and a bit high blood pressure. should i see an endocrinologist or someone as i dont want to be a pharmacy junkie when i get old? Are there people who work for you and with you that can guide me through a process of getting well without me absorbing all this reading input. its too much. thanks

    Reply

    • Jen – thank you for reaching out. <3 I am so sorry to hear you are struggling. ❤️ I understand how overwhelming this can be. Hashimoto’s is often a combination of food sensitivities, nutrient deficiencies, adrenal issues, gut issues as well as an impaired ability to get rid of toxins. Any of those things would prevent a person from getting better.
      Hashimoto's is very much an individual condition. While there are root cause commonalities, each person will have their own or in some cases, more than one root cause. You will have to start with the simplest modifications, by removing triggers, followed by repairing the other broken systems to restore equilibrium, allowing the body to rebuild itself. You will need to dig down to why the immune system is imbalanced in the first place and this will tell you how you begin to finally feel better, reduce your thyroid antibodies and even take your condition into remission. You will have to create your own health timeline. Look back at your overall history as far back as you can remember. Look for infections, periods of severe stress, the use of medications (especially antibiotics, antacids, and oral contraceptives), accidents, and exposure to toxins. These are events that may have contributed to Hashimoto's. Once you do, you will know what types of changes you need to implement to make yourself feel better. Take one step at a time! If you need further support, please check out the list of lab tests inside the “Testing” chapter of my book, Hashimoto’s Root Cause. I also offer a 12-week program, Hashimoto's Self Management Program. Here are some resources I hope you find helpful as well. ❤️

      BUILDING YOUR OWN HEALTH TIMELINE
      https://thyroidpharmacist.com/sample-health-timeline/

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

      Reply

  40. Is it common for doctors to start armour thyroid as a titration dose..
    What % of patients in your practice that you have seen, experienced hair loss on armour thyroid ?

    Reply

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