Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause Paperback – May 31, 2013

Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause by Izabella Wentz, Pharm.D., FASCP with Marta Nowosadzka, MD has a wealth of credible information on thyroid basics, symptoms, tests, and treatment. Izabella Wentz, a pharmacist and Hashimoto’s patient, has summarized three years of research in her book. I highly recommend her book, and I have attempted to summarize some of this information that I believe is crucial for every thyroid patient should know.Thyroid SymptomsAs many thyroid symptoms are very non-specific they are often disregarded by the medical community in the initial stages. Patients are dismissed with having depression, stress or anxiety. Thyroid patients are prescribed anti-depressants or anti-anxiety medications without consideration of thyroid function. Medical studies have shown that up to one-third of people who fail antidepressants report feeling better once started on Cytomel (a T3 thyroid hormone). Some patients have even been hospitalized and misdiagnosed as having bipolar disorder or schizophrenia when in fact they were suffering from thyroid imbalances. People with anxiety, depression or other mood disorders should have their thyroid function checked, especially TPO antibodies. Some individuals with lifelong psychiatric diagnoses have been able to recover after receiving proper thyroid care.Thyroid BasicsThe thyroid produces thyroid hormones that affect the function of just about every organ system in the human body. Thyroid hormones are responsible for stimulating the metabolism of the foods we eat, extracting vitamins, and producing energy from food. They are also vital to the production of other hormones as well as the growth and development of our nervous system. The thyroid also maintains our temperature. Indirectly, thyroid function affects every reaction in the human body, as the temperature has to be just right for these reactions to take place properly.T4 (Thyroxine) and T3 (Triiodothyronine) are the two main thyroid hormones. Only T4 and T3 are considered to be biologically active in the body, and T4 is 300% less active than T3. Twenty percent of T3 comes from thyroid secretion, while the remaining 80% comes from T4 when T4 is converted to T3 through the deiodination process (which removes on iodine molecule) in peripheral organs like the liver and kidney. However, stress, nutritional deficiencies, or other issues can impair the thyroid’s ability to function. Instead of converting T4 to T3, the body conserves energy by converting T3 into an inactive form of T3 know as reverse T3 (rT3). Reverse T3 is able to bind the receptor sites on the cell that T3 normally occupies, but it does not have the ability to unlock these receptors and enter the cell, thus not allowing the necessary reactions inside the cell to take place.Total T4 includes:• T4 hormones bound to protein. When bound to protein, thyroid hormone is not available to the cells and therefore can’t do its job in the body.• FreeT4, which are T4 hormones that are free or unbound to protein.Total T3 includes:• T3 hormones that are bound to protein, and are not available to the cells and therefore can’t do its job in the body.• Free T3, which are T3 hormones that are free or unbound to protein. Free T3 Includes reverse T3 (rT3) hormones that cannot enter the cells and therefore can’t do its job in the body. So, the only T3 that is beneficial to the body for thyroid function is Free T3 minus rT3.Recommended Thyroid Functions Tests• TSH Test: Low levels of T4 and T3 circulating in the blood signal the release of TSH (Thyroid Stimulating Hormone), while high levels of circulating T4 and T3 stop the release of TSH. The problem with using the TSH test to diagnose and treat thyroid function is that the amount of T3 and T4 circulating in the bloodstream does not address the issue of how much Free T4 and Free T3 is actually available in the cells to ensure proper thyroid function required to produce hormones, enzymes, neurotransmitter, and muscle tissue, and have a healthy metabolism.• Free T4• Free T3• rT3: TSH, Free T3, and Free T4 tests may be normal, but without factoring in the amount of rT3, patients may be suffering with thyroid symptoms.Hashimoto’s Thyroiditis and Recommended TestsHashimoto’s Thyroiditis is an autoimmune condition that results in destruction of the thyroid gland. Hashimoto’s is the most common cause of hypothyroidism in the United States, and accounts for 90% of cases of hypothyroidism. In most cases of Hashimoto’s thyroiditis, blood tests will reveal one or two types of anti-thyroid antibodies. Thyroid peroxidase antibody (TPOab) is the most common antibody present, and often antibodies against thyroglobulin (TGab) are found as well. These antibodies may appear decades before a change in TSH is detected. For this reason, TPO antibody screening is always crucial in suspected thyroid disease. Recommended tests are:• TPOab: Antibodies above 500 kU/L are considered aggressive, while antibodies of less than 100 kU/L are associated with a reduced risk of progressing to hypothyroidism.• Thyroglobulin AntibodiesWhy Are So Many Thyroid Patients Suffering with Thyroid Symptoms?Izabella Wentz’s research completely discredits the research currently used by traditional medicine. Traditional medicine’s diagnosis and treatment of thyroid function determines that any suppression of TSH, in spite of all other thyroid test results, indicates that the patient is hyperthyroid. This misuse of the TSH test results in a false diagnosis of hyperthyroidism; therefore, all the health risks they attribute to this erroneous diagnosis of hyperthyroidism are not valid. And could they defend their preference for T4 only medication if the patient’s medication was based on the results of all the lab work required to determine healthy thyroid function instead of basing it on their flawed research? Some of traditional medicines research is as follows:• Overreplacement – Overreplacement with T4 should be discouraged. Overreplacement causes subclinical hyperthyroidism (normal serum T4 and T3 and low serum TSH concentrations), or even overt hyperthyroidism. The main risk of subclinical hyperthyroidism is atrial fibrillation, which occurs three time more often in older patients with serum TSH concentration < 0.1 mU/L than in normal subjects. Patents with subclinical hyperthyroidism, particularly postmenopausal women, may also have accelerated bone loss. It is therefore important to educate patients about the potential adverse effects of overtreatment with T4.• Combination T4 and T3 therapy – Some hypothyroid patients remain symptomatic in spite of T4 replacement and normal serum TSH concentrations. As an example, in a large community-based questionnaire study of patients taking T4 who had normal serum TSH concentrations, 9 to 13 percent hypothyroid patients might benefit from substitution of some T3 for T4, an idea that has now been evaluated in multiple randomized trial, almost all of which showed that combination T4-T3 therapy does not appear to be superior to T4 monotherapy for the management of hypothyroid symptoms. In some trials, patients preferred combined therapy to T4 monotherapy; however, in one of those studies, patients were given overzealous doses of thyroid hormone resulting in mild hyperthyroidism. In general, clinical trials of combination T4-T3 therapy have not successfully replicated physiologic T4-T3 production.The Future for Thyroid PatientsThe truth about the current diagnosis and treatment based on the TSH test is that it has caused thyroid patients years, if not a lifetime, of suffering. By treating many thyroid symptoms, such as depression, fibromyalgia, CFS, stress and anxiety, etc. as separate illnesses, the medical profession and the pharmaceutical industry are the only ones who benefit. And the scary thing that I am now noticing is that as older doctors retire, the younger doctors taking their place have been trained to diagnose and treat thyroid function based on traditional medicine’s research as if it is sacred scripture. The only hope that thyroid patients have now are alternative medicine doctors who understand thyroid function and know and use the correct lab tests. I was informed this year (2017) that the lab tests ordered by my Naturopathic doctor are no longer covered by Medicare and Medicaid insurance. Are these doctors being targeted to be phased out? What does the future hold for thyroid patients?For additional information on why the medical profession should reassess the validity of using the TSH test and their preference for T4 only medications, read my review on Living Well with Hypothyroidism by Mary Shomon.

This book has literally saved me MONTHS of research on my own. Dr. Wentz has created a wonderful resource not only for those suffering from Thyroidism, but frankly from ANY auto-immune disease. She has clear to follow explanations of how the thyroid functions, followed by chapter after chapter on how to heal. The best part of the book is her supplement guide, which includes not only what to take, but how it works, what is does, and what dosages are best.I don't know if my personal story will be helpful, but let me start by explaining what I learned on my own versus what I learned from this book.I was diagnosed with Hashimotos, but normal thyroid hormone levels, despite having *all* of the symptoms of hypothyroidism. I saw three endocrinologists, three GPs, two neurologists, numerous chiropractors and massage therapists, two acupuncturists, and even a life coach and hypnotist (pretty much any health related professional whose bio suggested they might be able to help). I tried *everything*, and I mean everything, to get back on track but it just wasn't working until I found this book.This book introduced me to two concepts that were critical: Functional medicine, and Hashimoto's Gluten sensitivityThis led to several significant changes. I *fully* committed to being gluten free. No bread, no soy sauce, no tempura sushi, not even cookie dough ice cream. I scoured labels, googled everything I ate, and was generally an intolerable friend to go eat out with ;) But it worked. That was the first huge leap forward.The second came when I started looking for functional medicine doctors in Austin, TX and following the supplementation suggestions put forward in this book. I found Dr. Ben Anderson in Austin, TX who has been a life saver for me, and even for one of my friends now dealing with similar issues. I'd already been taking a mix of supplements, but he helped me find even better supplements that were attuned to my body. And he did hormone testing, which showed major adrenal fatigue.So, with a few tweaks, here's the final list of supplements I'm on (but I'm not a doctor so consult yours first!)Empty Stomach (AM):- Licorice drops- Probiotic- Saccharomyces BoulardiiLunch:- Glutamine- Methyl B12 (my Dr suspects a MTHFR gene mutation; regular B12 wasn't helping but this works great)- NAC- Zinc (this was huge for me; gave me lots more energy)- SeleniumBedtime:- Magnesium- CoQ10- Probiotic- Fish Oil w/vitamin DMany of these don't have to be taken with food and the order could be switched up. This was just what worked for me based on balancing the load of how many things I was taking each time of day. I'd recommend chatting with your doctor about lab work for vitamin deficiencies and reading Dr. Wentz's supplement guide.Also, keep hunting for a functional medicine doctor in your area who charges reasonable prices. The first one I found got great reviews but their "autoimmune cure" package was $4k. Crazy! Several others weren't much better at $750 for a one hour consult. I found my doctor through a case study in the book "Why isn't my Brain Working." That book had lots of case studies with doctors from across the country, so you might start there if you are looking for a local functional medicine specialist.Good luck everyone!