Hashimoto’s Webinar

This Q & A was originally posted in April of 2015, following a Hashimoto’s webinar. I have since developed new articles and resources for Hashimoto’s that might be helpful for you. For the latest information on these topics, please visit the following:

• Hashimoto’s and Graves’ Remission after Helicobacter Pylori Eradication
• Iodine and Hashimoto’s
• How Betaine with Pepsin Can Help with Hashimoto’s
• Food Sensitivities and Hashimoto’s
• Natural Solutions to Managing Pain with Hashimoto’s
• Are Your Adrenals Sabotaging Your Health?
• Which Thyroid Medication is Best?
• Top 10 Thyroid Tests and How to Interpret Them
• How Supporting the Liver is Key to Recovering From Thyroid Disease
• Candida and Hashimoto’s Connection

A Patient-Centered Approach To Hashimoto’s

Many of you had some great questions for me. As I was not able to answer all of them during the webinar, I am addressing them in this blog post…Happy reading!

QUESTION: I have H. pylori but suspect other gut parasites. What is your recommendation? I had THREE rounds of antibiotics and developed C Difficile. Cured by a functional med doc who prescribed turmeric and ginger. But still have H. pylori. Please address H. pylori.

H. pylori has been recognized as a trigger for Hashimoto’s and eradicating it has helped some people go into remission.  Things to consider for H. pylori- your family members and pets may reinfect you- treatment for them may be helpful. For people with H. pylori that do not want to take antibiotics, I recommend a more gentle herbal treatment for H. pylori consisting of Mastic gum with DGL (three times per day for 60 days) or Matula Tea. Taking the beneficial yeast S Boulardii along with the herbal protocol will prevent the development of C. Diff. and help eradicate the H. pylori.

QUESTION: Do you recommend eating seaweeds for iodine?

I do not recommend seaweeds for those with active Hashimoto’s due to their high content of Iodine and their propensity to modulate the immune system. Additionally, excess iodine can perpetuate/worsen the autoimmune attack in Hashimoto’s and lead to additional thyroid cell destruction. Before considering iodine supplementation, I urge you to get tested for iodine and other mineral deficiency. Most people with Hashimoto’s are actually not deficient in iodine, and a slight iodine deficiency may even be helpful for Hashimoto’s. In the case of an actual deficiency, it’s difficult to estimate the amount of iodine in seaweed, so I would recommend starting with a supplement, at a very low dose and increasing as tolerated.

Great process map, it really helps to see what’s going on with Hashimoto’s (referring to slide #8).

Thank you! It helped me to lay things out visually, and I hope it helps you. You can see my full Hashimoto’s process map.

QUESTION: Do you have any recommendations for children?

My daughter struggles with anemia, acid reflux, constipation as well as eczema. Her thyroid levels look good but she still continues to have these symptoms.  Her doctor has her taking an iron supplement, but I worry about how that affects the balance of other minerals in her body such as zinc and copper. How do I make sure to keep her balanced and help with these different issues? It seems if you treat the anemia, then you increase constipation and other issues.?

For children (and adults), I always recommend starting with diet. Are they gluten, dairy, and soy free? Are they eating a nutrient dense diet with fermented foods?

Implementing those changes can help many symptoms. For example, some cases of anemia can be helped by eating liver, others may resolve by going gluten free. Acid reflux is often caused by food sensitivities. Most of the interventions recommended in my book, Hashimoto’s: The Root Cause can be done with children, with the exception of dosing of supplements. I suggest you work with a functional medicine doctor that is familiar working with children.

QUESTION: I was diagnosed at 16 w/Hypothyroidism. I love your book and I’m almost done. I have been searching for something like this for years. Question, you mention on page 147 about not taking Advil (which my BFF). Can you recommend something else to take for headaches/migraines?

The same things can trigger migraines as Hashimoto’s, including Hashimoto’s and food sensitivities, and infections like H Pylori, as well as things like food dyes; artificial sweeteners, etc. can act as triggers. I recommend Suzy Cohen’s new book- Headache Free

I believe unforgiveness has a lot to do as a trigger. And other emotional and spiritual issues.

You are right; unforgiveness is a huge emotional burden that stresses our thyroid and adrenals, which in turn make our body weaker and more susceptible to food reactions, infections, stressors, etc. The onset of most autoimmune conditions has been precipitated by stress. I think you’ll find the book “You’re not crazy, you’re not alone” very helpful. Author Stacey Robbins talks about the emotional aspect of Hashimoto’s.

QUESTION: What was the name of the Dr. at Mass General again?

Dr. Alessio Fasano is a gastroenterologist that specializes in Celiac disease and has found a connection between autoimmunity and intestinal permeability. Here’s a post I wrote about reversing autoimmunity and Hashimoto’s.

So if a person already has an autoimmune disease is it worth spending the money to test for intestinal permeability since it is assumed it already exists?

I don’t think that it’s absolutely necessary to test for intestinal permeability if you already have an autoimmune condition, as research shows that everyone with an autoimmune condition has intestinal permeability. It may be helpful to test it as a baseline, and then do follow-up testing after various interventions to see if there was any improvement.

QUESTION: Thanks, Dr. Wentz for all your great information. My free T3 is in the mid rage and is good, so my conversion from T4 to T3 is excellent. My T4, however, is always just below the range – does this matter? And what are the causes of the low T4? I am on desiccated thyroid – perhaps it is the composition of the desiccated thyroid that causes low T4 – and if this is the case, should I supplement with synthetic T4 a bit? I feel great but my hair and nails have always been weak and I do have cold intolerance. But energy levels are great.

Some people may have different needs than the standard doses of T4/T3. I encourage you to work with your doctor and compounding pharmacist to get an appropriate dose for you.

QUESTION: How do you deal with a doctor who will only test for TSH and the antibodies, but not free T3 or free T4? He said those numbers would not be useful since I am already on Synthroid and those numbers wouldn’t change my treatment anyway?

I’m not sure you will be able to influence your current doctor if you have already asked and he/she said no. I would encourage you to find a doctor that is more open minded and lets you be a part of your own healthcare team, or order the labs on your own through ZRT Lab. Testing for free T4 & Free T3 will tell you what amount of hormone is bioavailable and whether you are converting T4 to T3 properly.

QUESTION: My TSH is over 11 (this is a first, it’s usually normal on thyroid hormones), but my T3 and T4 are normal, so my doc says the TSH number is irrelevant. Do you agree? I have hypothyroid and Hashimoto’s.

When the TSH is elevated, and T3 and T4 are still normal, this is considered subclinical hypothyroidism. It means that your thyroid is working overtime to keep up with demand. Taking thyroid medications in subclinical hypothyroidism has shown to reduce the thyroid antibodies and symptoms.

One comment about gluten free: I tried a gluten free diet and ended up with Diverticulosis. There is a nationwide outbreak of diverticulitis since gluten free became so popular.

I’m sorry to hear that! While I have not heard of gluten free diet being a trigger for diverticulitis, I encourage all those thinking about undergoing a dietary change to work with a physician, nutritionist or dietitian. We are all different and various individuals will need different levels of fiber, protein, fats and carbohydrates.

QUESTION: I have tried for years to get on desiccated/natural compounding T4/T3 and every time, I have terrible reactions with the combo.  A doctor has told me that I am allergic to my hormones.  Any suggestions on this?  Please help!!

Have you tried filler-free compounded thyroid medications made by compounding pharmacists? Often times people react to the fillers in the medications, and sometimes Thyroglobulin and Thyroid peroxidase that may be found in the NDT, but will not be found in compounded thyroid medications, and not the actual hormones. Some common reasons for reacting to medications may be due to adrenal fatigue, so I encourage you to have an adrenal saliva test.

QUESTION: When going off sugar what is your opinion of fruit in the diet?

Some people need to cut out even fruit is they have severe blood sugar imbalances/Candida.

If I get the blood and saliva tests done for adrenals that you recommend in your book and the results are considered relatively normal, is it still possible to have adrenal fatigue/issues? I ask because I have always been very sensitive to stimulants, can’t have any caffeine, herbal treatments often give me bad jitters, can’t have epinephrine, sensitive to all meds with possible stimulant effect, sensitive to environmental stimulation, history of panic disorder (in past before hypo symptoms started).  Can you have an adrenal problem even though your test levels are “normal”, just like you can have Hashi’s even though your lab tests show a normal hormone range? I just have always felt this is such a key thing with me but it’s harder than Hashi’s to get to the core of this matter. Also, I’ve read often you can’t fix thyroid and Hashi’s until you fix adrenals.

I would encourage you to do another adrenal saliva test, as not every company has accurate lab results. The initial two companies I tested with showed that my adrenals were normal, but another more accurate test showed that I was in Stage 3 adrenal fatigue.

QUESTION: Do you have any thoughts on the effectiveness of L-Glutamine in helping to heal the gut?

Glutamine is required for gut lining integrity, and many people with Hashimoto’s may be deficient, so taking L-Glutamine it will help with gut repair. However, make sure that you eliminate the potential culprits that are causing the gut to be permeable, such as food sensitivities or infections.

I took 100mcg of Selenium and got the jitters bad after three days. Lab results showed normal levels but B6 was way too high. Could the Selenium have just triggered B6 into bad jittery reaction? Want to benefit from Selenium but don’t want bad reaction. Side note, I eat only things I make so don’t get normal salt, only sea salt iodine free that I add.

I would recommend a comprehensive nutrient analysis including iodine test to see what supplements you might benefit from.

QUESTION: I’ve always wondered if supporting the immune system makes it “stronger” in its attack of the thyroid. Conversely, if the thyroid is strengthened, does that then stimulate the immune system to do a better job of attacking?

“Supporting the immune system” is a misnomer, as it can mean a variety of different things. There are various immune stimulating substances that can make the autoimmune attack worse. There are immune modulators that can improve the immune system’s sensitivity to triggers, and make it more precise and less likely to attack our own tissues.

QUESTION: You mentioned toxins could be a trigger, what tests would you recommend to test for toxins?

I would start with the Mercury test (link)

My Root Cause Recipes are very nutrient dense and I think the recommended diet can be helpful for people with Hashimoto’s.

JUST A COMMENT:  So far you are verifying many of the treatments my homeopathic nutritionist has suggested and have worked for me. It is a huge relief hearing it from you as well! Will we get a copy of the slides?

I’m so glad to hear that! Hope these changes help. You can watch the presentation again here.

If you are able to get Hashimoto’s into remission, are you able to reduce supplements such as NAC, Selenium, etc.?

Yes, as long as you are getting enough of the nutrients for a nutrient dense diet.

QUESTION: Do you use blood tests to look for infections of EBV and Yersinia? For Candida, do you recommend doing a urine test (Organic Acids Test)? What supplements do you use to address EBV and Yersinia infections?

I recommend gut testing for Yersinia and Candida. The organic acids test can also be helpful. For EBV, the key is getting your Vitamin D levels up, as well as taking really good care of your adrenals.

QUESTION: What do you feel about low dose naltrexone?

Low dose naltrexone can be a very helpful immune modulator to suppress the autoimmune process. I have seen TPO antibodies drop from the 1000+ range to the 100 range in some as well as a need to reduce thyroid antibodies and a resolution of symptoms. You can read my article about LDN and thyroid.

QUESTION: Can you repeat what you said about the goitrogens veggies and how they may not affect everyone?

Most goitrogens are not likely to suppress thyroid function unless you have an iodine deficiency, most people with Hashi’s do not. You can read my article about thyroid and goitrogens for more information.

QUESTION: What were all the hidden infections to test for? How to heal & rebuild gut after?

I recommend stool testing to find bacteria and parasites that can set off the immune system. Glutamine is very helpful for rebuilding the gut after the infections are eradicated.

QUESTION: I constantly have a sore throat, is this the start of a goiter?

A sore throat could mean many different things, so I would encourage you to get a thyroid ultrasound if you are concerned about your thyroid.

QUESTION: How can I get my scalp to stop hurting?

A painful scalp could be an indication of a variety of different things, such as sensitivities to products you are using or consuming. You can try using gluten free, organic shampoos or doing an elimination diet.

QUESTION: Can you talk about reverse T3?

T4 gets converted into reverse T3 instead of active T3 in times of stress, nutrient deficiencies, toxicity, etc. Reverse T3 blocks thyroid receptors instead of activating them- this could result in thyroid symptoms with “normal” TSH. I cover reverse T3 in greater detail in my book, Hashimoto’s: The Root Cause.

QUESTION: Most thyroid support products contain iodine if iodine levels are normal, would it be ok to supplement with those products?

I would not recommend taking iodine if you have Hashimoto’s and have normal levels of it.

QUESTION: Do you have recommended brand supplements?

Yes, I recommend the Pure Encapsulations brand. It’s a hypoallergenic, professional line of supplements that undergoes rigorous quality testing.

You can find out more about the supplements I recommend for Hashimoto’s.

QUESTION: While we are starting this process, what type of replacement thyroid do you recommend?  Synthetic or Natural?

Your medication needs to be tailored to you. Some people do better with one over the other. Read my recent post about thyroid medications for more information.

QUESTION: Does ZRT accept HSA cards for purchasing testing kits?

Here is some information about ZRT Lab billing and HSA accounts

QUESTION: What helps fatigue?

Here’s a post I wrote about fatigue: Overcoming Thyroid Fatigue

QUESTION: I am vegan and gluten free, what can eat other than Soy?

See if you tolerate pea protein. Here’s an article about diets that have been helpful in Hashimoto’s.

QUESTION: Are there any thyroid meds available that do not contain gluten or would they have to be compounded?

Most thyroid medications are gluten free. Here’s an article about gluten free thyroid medications.

QUESTION: When we get testing through an outside source such as ZRT, how do we go about getting the blood draw?

ZRT Lab has test kits that require a tiny amount of blood. Much like using a home diabetes test. They send along a lancet you can use to pierce the side of your finger to obtain the small amount of blood.

QUESTION: How about the effect of iodine used with some X-ray testing?

This can be problematic and can bring on a thyroid storm. Please speak to your doctor about alternatives.

QUESTION: Is there a test to find out if you have a Candida issue or Parasite issue?

Yes, I recommend the GI Effects Profile from Genova lab.

Do any antibodies indicate Hashimoto’s? I keep testing under the limit, but my doc keeps saying that ANY antibodies means I have Hashi’s and that it’s just not flaring right now. Thanks!

Antibodies of <35 (on most blood tests) are generally thought to indicate that you are in remission from Hashimoto’s. Some believe that thyroid antibodies serve a “cleanup” functions and may be present without Hashimoto’s, others that if you have antibodies, you have Hashimoto’s. You can get a thyroid ultrasound to see if your thyroid has changes consistent with Hashimoto’s.

QUESTION: How often per year should a long-term patient be tested?

If you are well controlled and don’t have symptoms, 1-2 times per year for TSH, Free T3, Free T4.

QUESTION: Is there is any link of Hashimoto’s and blood pressure?

Emerging research is showing that high blood pressure, like Hashimoto’s, may have an underlying autoimmune mechanism. Some people with Hashimoto’s and adrenal fatigue may have low blood pressure.

QUESTION: If I am tested by a blood test for food sensitivities and show no celiac or other food sensitivities, will diet still help?

Eating a nutrient dense diet will help everyone. Food sensitivity testing is not always 100% accurate. There are some tests that are better than others; the gold standard test is doing an elimination diet. Most people with Hashimoto’s do not have Celiac disease but feel much better off gluten and dairy.

QUESTION: Where can we get a list of functional medicine docs that work with ZRT?

Please click to view a list of practitioners.

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.

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