Dr. Nicole Sundene
Hypothyroidism and thyroid disease are the #1 conditions I treat in my Holistic Women’s Health and Hormone practice. Before I answer a lot of the questions I am commonly asked about hypothyroidism and discuss the best natural and prescription treatments, let me first take a minute to explain the process of how I help my patients with hypothyroidism achieve lasting solutions with natural thyroid hormones, herbs, nutrition and supplements.
I wish treating hypothyroidism was as simple as the current medical model that constantly fails women. Women with hypothyroidism are oftentimes frustrated because they are stuck in an antiquated hormone treatment system of:
Take X Thyroid Drug for X Symptoms
Oftentimes my thyroid patients are still complaining of common thyroid symptoms such as weight gain, chronic fatigue, depression, anxiety, cold intolerance, hair loss, heart palpitations, high cholesterol, insomnia, poor libido, dry skin, eczema, psoriasis, acne, and abnormal female hormones. All while their Family Doctor or Endocrinologist is saying the dose is fine. Half the time the dose is not properly tested and that is why it is not correct.
In Naturopathic and Functional Medicine, the body will continue to scream about its thyroid symptoms until we get the dose adjusted properly, changed to natural thyroid hormone and off the synthetic garbage.
After all, the thyroid is the “Mother of the endocrine system,” so we all know that when “Mommy” is not happy that none of the “Children” relying on her in female hormone and adrenal land will be happy! 😉
Here is the exact Holistic Thyroid detective process I perform as a Holistic Thyroid Doctor to fix hypothyroid symptoms:
#1 Why do you have hypothyroidism in the first place?
#2 What is the “Root Cause” of your hypothyroidism? Hint: It is different for each thyroid patient!
#3 Are vitamins, minerals, and nutrients the thyroid needs to make T4 and T3 hormones deficient?
#4 Assess adrenal function for women with chronic fatigue, anxiety and insomnia.
#5 Teach women my healthy hormone balancing Naturopathic meal plans and recipes my nutritionist designed to specifically help my overweight thyroid patients lose weight and balance female hormones.
#6 Addressing the gut inflammation is oftentimes why my patients have hormone imbalance in the first place, looking at the right nutrition for the individual patient, eliminating food triggers, testing the microbiome, and ruling out dysbiosis is critical for many of my thyroid patients.
#7 Continue to monitor the thyroid with FREE THYROID LEVELS AND NOT JUST USELESS TSH via blood hormone labs to confirm your thyroid function is OPTIMAL and that you are not running on an “Empty tank of gas” or at the bottom of the “hormonal normal range” which is not optimal, yet many doctors that do not specialize in hormones will decide it is totally fine despite being low and the patient frustrated by multiple annoying symptoms such as weight gain, hair loss, and chronic fatigue.
My TSH RANT: Please be advised if the doctor or Endocrinologist monitoring your thyroid is just checking TSH, or is checking total thyroid hormones and not free levels then they are not educated enough on this topic to be managing your hormones in my opinion. This is the #1 reason why my poor thyroid patients is suffering so badly. Checking TSH is 90's medicine and it is time for a better, modern, educated thyroid doctor!
If I treated my menopause patients this way, people would think I was insane to just check their FSH and not actual female hormones. Let's imagine if I stopped checking estrogen, progesterone, and testosterone levels to adjust menopausal women's bioidentical hormones and instead just adjusted hormones off of FSH or the message the brain is sending to the ovaries to make more hormones. Just as TSH is the message the brain is sending to the thyroid that it needs to make more hormones. Managing thyroid this way is a grave disservice to women everywhere.
We have much more sophisticated better ways to manage hypothyroidism now, thankfully! The only way we can stop this madness is to properly educate women and make sure they know what to expect on their labs tests so they can immediately fire their doctor if there is less than three thyroid tests being monitored.
I digress from my TSH rants, and want to move on to my "Root Cause" rant, because I want to take the time to investigate and understand #1 and #2 on my list, I sadly have seen many of my thyroid patients fail to improve over my seventeen years of experience working as a Naturopathic Hormone Doctor. Sadly then Natural Medicine also fails, and I don’t get to receive the “Joy of Fixing you” because I don't understand why the symptoms are here in the first place.
The real reason why most women don't feel good on synthetic synthroid and levothyroxine is because...
#1 Levothyroxine is a factory made synthetic compound.
#2 Levothyroxine is the dreadful "T4 monotherapy" that makes most of my thyroid patients fat because it needs to be converted to T3 to actually be useful. The T3 from the thyroid tells every cell in our body to work...somewhat like flipping on a light switch on or off.
#3 Lack of T3 means less collagen production, hair growth, and joint repair. Thyroid hormones set the pace for collagen production, along with metabolism. Therefore it is imperative that the thyroid levels for my chronic pain, autoimmune, Hashimotos, Rheumatoid Arthritis , and Lupus patients are in the optimal range and not just “normal.” Many of my unhappy thyroid patients are "Poor Converters" that are unable to convert the store hormone, T4 (Levothyroxine, Synthroid) to the active hormone that burns fat and gives energy=T3. This is why I firmly believe in natural thyroid hormone for women, and the majority of the women in my hormone practice ~95% are on natural thyroid hormone.
While many women are totally fine with their hypothyroidism utilizing the standard synthetic hormones synthroid and levothyroxine, many women specifically seek me out to fix their hypothyroidism related issues because they have been given these synthetic thyroid hormone replacements, yet still have symptoms and just don’t quite feel right.
I want every woman in my practice to be a success story. So please do treat yourself to a Naturopathic visit with me if you also want real answers, want the right nutrition for your body, want natural hormones, like to use herbal medicine, and want me to fix the underlying digestive and adrenal issues that are most often causing low thyroid function.
If that sounds like what you need to finally solve the mystery of your frustrating thyroid symptoms then please pop over to my SCHEDULE page and treat yourself to a Naturopathic visit! I would be happy to help! As a thyroid patients myself, this is of course one of my favorite hormone subjects! Now let me answer the most common questions I am asked about hypothyroidism.
WHAT IS HYPOTHYROIDISM?
Hypothyroidism is a medical condition characterized by low thyroid hormones in the body affecting vital physiological functions. Thyroid hormones, including T3 and T4, are secreted by a small, butterfly-shaped Thyroid Gland located in the front of the neck. Different factors impair the function of the thyroid gland that results in underactive thyroid or insufficient production of the hormone to meet the daily body requirements. [1, 2]
Remember that a low thyroid hormone level or hypothyroidism negatively affects lung function, metabolism, neurological function, body mass index, heart rate, and gastrointestinal health. It is estimated that about 4.6 percent of the US population, or approximately 10 million Americans have hypothyroidism.
LOW THYROID: WHAT ARE HYPOTHYROID SYMPTOMS?
The hypothyroidism symptoms vary among individuals. However, it involves the following signs and symptoms. [1, 2, 3]
WHAT ARE THE RISK FACTORS FOR HYPOTHYROIDISM?
Hypothyroidism can occur in any individual, but certain risk factors increase the chances of its development. These risk factors include:
Also, the presence of certain medical conditions increases the risk of hypothyroidism. These conditions include pernicious anemia, Sjogren's syndrome, lupus, diabetes, Turner syndrome, and rheumatoid arthritis. [1, 2, 3]
WHAT CAUSES HYPOTHYROIDISM?
Different factors significantly impact the function of the thyroid gland and lead to the development of hypothyroidism. [1, 2, 3] These include:
Hashimoto's Thyroiditis is the most common cause of hypothyroidism. It is an autoimmune disease where the body's immune system attacks the thyroid gland. That results in the development of thyroid inflammation and leads to an impaired thyroid hormone level. Hashimoto's disease is the most common thyroid disorder in America, affecting around 14 million people. It is seven times more prevalent in women than men. Individuals with Hashimoto's disease are also at high risk of other autoimmune diseases. [7]
TYPES OF HYPOTHYROIDISM
Hypothyroidism is divided into three main types based on the etiology of low thyroid hormone in the body. These include:
Moreover, a rare type of hypothyroidism caused by an abnormal expression of the deiodinase three enzyme in tumor tissues is termed Peripheral or Consumptive hypothyroidism. The elevated concentration of the deiodinase three enzyme inactivates thyroid hormone.
WHAT IS SUBCLINICAL HYPOTHYROIDISM
Subclinical hypothyroidism is an early hypothyroidism form characterized by an abnormal thyroid-stimulating hormone and a normal thyroxine level with minimal or no symptoms. It occurs in about 15% and 8% of women and men respectively over the age of 60 years. Remember that subclinical hypothyroidism shares the same causes, similar symptoms, and treatment options to other hypothyroidism types. [6]
It is important to mention that levothyroxine is indicated during pregnancy or in women who want to conceive. It helps prevention of harmful effects of hypothyroidism both on pregnant women and fetal development.
MEDICAL COMPLICATIONS OF HYPOTHYROIDISM?
Untreated hypothyroidism increases the risk of following medical conditions or aggravates their symptoms. [3]
HOW DO WE DIAGNOSE HYPOTHYROIDISM?
Sometimes the diagnosis of hypothyroidism is difficult due to the number of symptoms confused with other medical conditions. Medical history, family history, physical examination (enlarged thyroid, dry skin, puffy eyes, etc.), medical symptoms, and different blood tests are performed to diagnose hypothyroidism. The blood tests such as thyroid-stimulating hormone tests and evaluating the level of thyroxin level are highly recommended for hypothyroidism diagnosis. Plus, the physician may order a blood test for Hashimoto's disease to confirm the presence of hypothyroidism. Note that high thyroid-stimulating hormone levels and low levels of thyroxine indicate an underactive thyroid or hypothyroidism. [2, 3]
WHAT ARE THE BEST TREATMENTS FOR HYPOTHYROIDISM?
Hypothyroidism treatment involves the restoration of normal thyroid hormone levels in the body. Moreover, the treatment aims must include complete control over the hypothyroid symptoms, normalization of thyroid-stimulating and thyroxine hormone level, avoidance of overtreatment, and prevention of medical complications associated with hypothyroidism. It is important to know that hormone replacement such as armour thyroid or levothyroxine, and cytomel are the primary prescriptions used for hypothyroidism management. [4, 8]
WHAT IS NATURAL THYROID HORMONE REPLACEMENT THERAPY?
In MD hormone replacement therapy, synthetic thyroid hormone levothyroxine is prescribed to restore normal thyroid hormone levels in the body. The administration of levothyroxine (T4) maintains an optimal level of thyroxine and thyroid-stimulating hormones that prevent or manage hypothyroidism symptoms. Moreover, it regulates the high cholesterol level, metabolic dysfunctions and also helps the management of weight gain. Primarily, hormone replacement therapy is indicated for a lifetime, but the dose may vary with the patient's condition. Sometimes, Liothyronine (T3) combined with Levothyroxine (T4) is given to the patients when they do not feel better with single hormone therapy. At the beginning of therapy, a levothyroxine dose of 50-75 µg/day is indicated to treat mild to moderate hypothyroidism. However, the initial dose of levothyroxine depends on the patient's weight, age, pregnancy status in women, lean body mass, hypothyroidism type, TSH level, and other medical comorbidities. [4, 8]
Note that all hypothyroid patients respond well to hormone replacement therapy. However, in severe myxedema (life-threatening hypothyroidism), the treatment approaches involve the parenteral administration of levothyroxine (T4), antibiotics, steroids, and optimal oxygen supply. [4, 8]
It is important to know that always consult and take great care about the dosage of thyroid hormone, as a low dose can't benefit the hypothyroidism symptoms. In comparison, the high doses will result in the development of hyperthyroidism. Thus, it is advised to regularly check the thyroid-stimulating hormone and levothyroxine level for the first 6-8 weeks during hormone replacement therapy; after getting stable, check the levels at an interval of 6 months or can be extended up to 12 months. [4, 8]
The clinical benefits of hormone replacement therapy appear within 3-5 days, but the complete restoration takes 4-6 weeks. Moreover, the normal TSH reference level regulation may take several months due to the modulation of the hypothalamic-pituitary axis. Plus, it is recommended not to switches between different brands or generic formulations of levothyroxine to avoid dose fluctuation. [4, 8]
Different thyroids hormone formulations are available in the market for the management of hypothyroidism. The most popular formulation include Armour Thyroid, Nature Thyroid Tablet, NP Thyroid, Synthroid, and Cytomel. These medications are natural thyroids hormone formulation obtained from animal thyroid glands (usually a pig's) intended for hypothyroidism treatment. Side effects involve temporary hair loss due to the drug-body adjustment. Note that regularly confirm the normal thyroid level to avoid the hyperthyroidism symptoms. [4, 8]
The American thyroid association recommended the evaluation of certain situations or conditions that may alter the thyroxine level. Such as examine the patients for gastrointestinal disorders who need a higher dose of levothyroxine. Plus, always talk with a qualified physician about the initiation or discontinuation of other hormone replacement therapies such as androgen and estrogen hormone during TSH level assessment or levothyroxine therapy. Moreover, other medications such as tyrosine kinase inhibitors, phenobarbital, sertraline, phenytoin, carbamazepine, and rifampin may also alter the Thyroxine level. Also, the concomitant use of proton pump inhibitors, sucralfate, and supplements such as calcium, magnesium, etc., interfere with the levothyroxine absorption. Furthermore, consume the levothyroxine before 35-45 min before breakfast or at least 3 hours post-meal at bedtime for optimal absorption.
Remember that if the hypothyroidism symptoms do not ease with hormone replacement therapy, one must consider and check for other medical causes instead of increasing the levothyroxine dosage. [4, 8]
Surgery
Hypothyroidism is rarely treated with surgical procedures. Surgery has opted in case of large goiters that negatively impact the function of trachea-esophageal tracts. [4, 8]
Treatment Concerns:
Medical studies reported that thyroid replacement therapy exacerbates the co-existing adrenal insufficiency condition. So, remember that treat or evaluate the adrenal insufficiently condition before initiation of thyroid replacement treatment. Moreover, it is important to know that adrenal insufficiency can also occur with subclinical hypothyroidism. Plus, always treat or confirm the adrenal insufficiency during severe hypothyroidism (such as during myxedema coma) for rational treatment options. Furthermore, in heart conditions such as coronary artery disease, ischemic heart disease, etc., medical studies suggested that always start with the lower dose of hormones.
Then gradually increase the dosage over time for adjustment with heart conditions. At normal doses, levothyroxine does not cause any severe side effects. But overconsumption of overdosage of thyroid hormone increases the risk of poor muscle coordination, fatigue, insomnia, anxiety, excitability, tremors, feeling hotter than normal, osteoporosis, breathing difficulty, muscle weakness, atrial fibrillation, arrhythmias, heart palpitation, and increased appetite. [4, 5]
Natural remedies for hypothyroidism
Different natural interventions are also used to help the hypothyroidism symptoms. These include diet changes and administration of Supplements. Studies reported that selenium levels decrease during Hashimoto's disease and impair thyroxine levels. Selenium Supplementation helps regulate normal T4 levels and improve hypothyroidism symptoms. Moreover, a sugar-free diet also helps prevent aggravation of hypothyroidism symptoms. Studies showed that sugar consumption increases the risk of inflammation that impairs the conversion of T4 to T3 and thus may aggravate or favor the progression of hypothyroidism.
Further, the supplementation of Vitamin B12 improves certain hypothyroidism symptoms, including tiredness and healthy metabolism. Also, the consumption of probiotics restores healthy gut microbiota and improves gastrointestinal symptoms associated with hypothyroidism. Additionally, the supplementation of Zinc, Iron, Iodine, Vit D3 and Tyrosine combined with Iodine help regulate both the stimulating tissue hormone and thyroxine levels. [9]
Dr. Nicole Sundene, NMD
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
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Wow amazing thyroid article! I just happened to stumble upon your page and this was very helpful. I have Hashimotos and feel like this is one of the best articles to explain the different types of thyroid problems. Kudos!
Great blog! Thanks for being such an awesome thyroid doctor!