Iodine and Hashimoto’s Thyroiditis, Part 2

Mario Renato Iwakura’s guest series on the place of iodine and selenium supplementation in treatment of hypothyroidism continues. This is part 2. Thank you Mario! – Paul

In Part I (Iodine and Hashimoto’s Thyroiditis, Part I, May 24, 2011) we looked at evidence from animal studies that iodine is dangerous to the thyroid only when selenium is deficient or in excess, and that optimizing selenium status allows the thyroid to tolerate a wide range of iodine intakes. In fact, there were some hints (such as an improved CD4+/CD8+ T cell ratio) that high iodine, if coupled with optimal selenium, might actually diminish autoimmunity.

If that holds in humans too, we should expect that populations with healthy selenium intakes should see a low incidence of thyroid disease and no effect from iodine intake on the incidence of Hashimoto’s thyroiditis. Is that the case?

Korean Study

Dr. K [1] quotes a Korean study [3] of Hashimoto’s patients. Half restricted iodine intake to less than 100 mcg/day, the other half ate their normal seaweed and iodine. Of the 23 patients who restricted iodine, 18 (78%) became euthyroid in the sense of having TSH below 4.43 mIU/L, while only 10 (46%) of the 22 that did not restrict iodine became euthyroid. There was no measurement of symptoms at all, and no report of thyroid antibody titers after iodine restriction, so we don’t know if the iodine restriction relieved the underlying autoimmune disorder.

The selection of subjects for the two groups was odd. Group 1, the iodine restricted patients, had an extremely wide range of starting TSH, averaging 38 mIU/L but with a standard deviation of 82 mIU/L. Since all subjects began with TSH above 5 mIU/L, it’s clear that many of the Group 1 members had TSH near 5 and others had TSH well over 100 mIU/L. In comparison, Group 2, the controls, averaged a TSH of 11 mIU/L with a standard deviation of 11 mIU/L – less than 1/7 the standard deviation of Group 1. Few Group 2 members had a TSH above 30.

Table 2 presents the results. Mean TSH in Group 1 was reduced a little, but it did not even come close to normal. Since 78.3% of Group 1 had TSH below 4.43 mIU/L after 3 months, the other 21.7% had to have averaged a TSH above 102.2 mIU/L at the conclusion of the study. The standard deviation of Group 1 TSH at the end of 3 months of iodine restriciton was 71 mIU/L.

Meanwhile, Group 2 members still had a much lower standard deviation at the end of the study: 19 mIU/L.

A conclusion of this study was that “the initial serum TSH concentration was significantly lower in the recovered patients than in the non-recovered patients, which suggests that the possibility of recovvery is increasingly rare as the initial hypothyroidism becomes more severe.” Since Group 1 originally had a much larger fraction of members with very low TSH than Group 2 (plus a few with extremely high TSH to raise the average TSH), and the definition of recovery was a reduction of TSH to 4.43, perhaps it is not surprising that a higher fraction of Group 1 recovered.

Further calling into question the conclusion that lower iodine intake is beneficial is another observation. Looking at Table 1, we see that Group 2 (controls) had, at baseline, much higher iodine intake and higher urinary iodine excretion. Despite this, goiter size, TSH, antimicrosomal (MSAb) and antithyroglobulin (TGAb) antibodies were all lower!

A Japanese Study

A similar study with similar results was done in Japan [4].

In Asia, high iodine intake is due to high consumption of seaweed. Seaweed is high in naturally produced bromine compounds [5][6][7], arsenic [9][12][13], and mercury [9], and can accumulate radioactive iodine [8][9][10][11]. All these substances are known to interfere with thyroid function.

Bromide levels in urine in Asia are very high and are associated with seaweed consumption [6][7]. Values of 5 to 8.1 mg/l have been observed among Japanese, and 8 to 12 mg/l among Koreans.

It is quite possible that any benefits from “iodine restriction,” i.e. seaweed restriction, were due to reduced intake of bromine, arsenic, mercury, and radioactive iodine.

A China Study

Dr. Kharrazian [2] cites a study done in China [14] comparing three different areas: one with iodine deficiency (Panshan), another where iodine is more than adequate (Zhangwu) and a third where iodine is excessive (Huanghua). More than adequate and excessive iodine was associated with increased risk for subclinical and overt hypothyroidism.

But, another study [15], done in the same regions, showed that, coincidentally, Huanghua, the region with excessive iodine, and Zhangwu, the region with more than adequate iodine, had lower median serum selenium concentrations than Panshan, where iodine was deficient. Blood selenium concentrations were 83.2, 89.1 and 91.4 microg/L, respectively. So iodine consumption was inversely related to selenium consumption. Was it lower iodine, or higher selenium, that was beneficial?

TPOAb antibody levels were inversely associated with selenium levels. Patients with the highest TPOAb antibodies (>600 UI/ml) had lower selenium levels than patients with moderate and lower TPOAb antibodies (respectively 83.6, 95.6 and 92.9 UI/ml). [15]

Studies from Brazil, Sri Lanka, Turkey, and Greece

Dr K also cites a rise in Hashimoto’s incidence in Brazil, Sri Lanka, Turkey and Greece after salt iodinization began. Are these countries deficient in selenium? Well, lets see:

Brazil: The study was done in São Paulo, a city with a large Brazilian-Japanese population. Brazilian-Japanese have significant lower levels of Se than Japanese living in Japan [16].

Greece: Selenium status is one of the lowest of the Europe [17].

Turkey: Selenium status of Turkish children is found to be unusually low, only 65 ng/ml in boys and 71 ng/ml in girls [18]. Turkey is characterized by widespread iodine deficiency and marginal selenium deficiency [19].

Sri Lanka: Significant parts of the Sri Lankan female population may be selenium deficient [20].

One study, done in Egypt, measured iodine excretation in urine and its relation with thyroid peroxidase antibody (TPOAb) [21]. Although the abstract said that a significant correlation was found, this is far from reality, as we can see from Fig. 2.

Another study from Brazil [2] measured urinary iodine excretation and serum TPOAb and TgAb antibodies from 39 subjects with Hashimoto’s, none of whom were receiving treatment at the time of the study. Both antibody titers had no obvious correlation with urinary iodine.


Two discordant epidemiological studies

From the Netherlands, we have a prospective observational study looking at whether the female relatives of 790 autoimmune thyroid disease patients would progress to overt hypothyroidism or hyperthyroidism [22].

Although the relationship was not considered statistically significant, they found that women with high iodine intake (assessed through questionnaires) were 20% less likely to develop thyroid disorders.

Another study from western Australia (a region that has previously been shown to be iodine replete) measured urinary iodine concentration (UIC) of 98 women at 6 months postpartum and checked their thyroid status both postpartum and 12 years later [23]. UIC at 6 months postpartum predicted both postpartum thyroid dysfunction and hypothyroidism  12 years later:

The researchers concluded:

The odds ratio (OR) of hypothyroid PPTD with each unit of decreasing log iodine was 2.54, (95%CI: 1.47, 4.35), and with UIC < 50 lg/l, OR 4.22, (95%CI: 1.54, 11.55). In the long term, decreased log UIC significantly predicted hypothyroidism at 12-year follow-up (p = 0.002) … The association was independent of antibody status.

In short, the more iodine being excreted (and thus, presumably, the more in the diet and in the body), the less likely were hypothyroid disorders – not only at the time, but also 12 years later.

Dangers of selenium supplementation in iodine deficiency.

Selenium supplementation when iodine and selenium deficiencies are both present  can be dangerous, as the experience in northern Zaire, one of the most severely iodine and selenium deficient population in the world, shows [25].

Schoolchildren and cretins were supplemented for 2 months with a physiological dose of selenium (50 mcg Se per day as selenomethionine). Serum selenium was was very low at the beggining of the study and was similar in schoolchildren and in cretins (343 +- 190 nmil/L in schoolchildren, n=23, and 296 +- 116 nmol/L in cretins, n=9). After 2 months of selenium supplementation, the massive decrease in serum T4 in virtually every subject can be seen in fig. 4 below:

In schoolchildren, serum free thyroxin (fT4) decreased from 11.8 +- 6.7 nmol/L to 8.4 +- 4.1 nmol/L (P<0.01); serum reverse triiodothyronine (rT3) decreased from 12.4 +- 11.5 nmol/L to 9.0 +- 7.2 nmol/L; mean serum T3 and mean TSH remained stable. In cretins, serum fT4 remained the same or decreased to an undetectable level in all nine cretins; mean serum T3 decreased from 0.98 +- 0.72 nmol/L to 0.72 +- 0.29 nmol/L, and two cretins who were initially in a normal range of serum  T3 (1.32-2.9 nmol/L) presented T3 values outside the lower limit of normal after selenium supplementation; mean serum TSH increased significantly from 262 mU/L to 363 mU/L (p<0.001).

Another previous similar trial, this time done in 52 schoolchildren, reached the same results: a marked reduction in serum T4 [26][27]. This previous trial “was shown to modify the serum thyroid hormones parameters in clinically euthyroid subjects and to induce a dramatic fall of the already impaired thyroid function in clinically hypothyroid subjects” [27].

What stands out is the difference in the results between euthyroid schoolchildren and cretins/hypothyroids. Two months of selenium supplementation was probably not enough time to affect significantly the thyroid of the euthyroid schoolchildren (althougt already impacted T4 and fT4). But, in cretins and hypothyroids, where the thyroid was already more deficient, the impact was evident.

Conclusion and What I Do

Iodine and selenium are two extremely important minerals for human health, and are righly emphasized as such in the Perfect Health Diet book and blog. I believe they are fundamental to thyroid health and very important to Hashimoto’s patients.

A survey of the literature suggests that Hashimoto’s is largely unaffected by iodine intake. However, the literature may be distorted by three circumstances under which iodine increases may harm, and iodine restriction help, Hashimoto’s patients:

  1. Selenium deficiency causes an intolerance of high iodine.
  2. Iodine intake via seaweed is accompanied by thyrotoxic metals and halides.
  3. Sudden increases in iodine can induce a reactive hypothyroidism.

All three of these negatives can be avoided by supplementing selenium along with iodine, using potassium iodide rather than seaweed as the source of iodine, and increasing iodine intake gradually.

It’s plausible that if iodine were supplemented in this way, then Hashimoto’s patients would experience benefits with little risk of harm. Anecdotally, a number have reported benefits from supplemental iodine.

Other evidence emphasizes the need for balance between iodine and selenium. Just as iodine without selenium can cause hypothyroidism, so too can selenium without iodine. Both are needed for good health.

A few months after I was diagnosed with Hashimoto’s I started 50 mg/day iodine plus 200 mcg/day selenium. If I were starting today, I would follow Paul’s recommendation to start with selenium and a low dose of iodine, and increase the iodine dose slowly. I would not take any kelp, because of potential thyrotoxic contaminants.

Currently I’m doing the following to try to reverse my Hashimoto’s:

  1. PHD diet and follow PHD book and blog advices to enhance immunity against infections, since infections seems to be implicated in Hashimoto’s pathology [28][29][30]. I give special attention to what Chris Masterjohn calls “traditional superfoods”: liver and other organs, bones and marrow, butter and cod liver oil, egg yolks and coconut, because these foods are high in minerals, like iodine, zinc, selenium, copper, chromium, manganese and vanadium, all of which seems to play a role in thyroid health [31];
  2. High dose iodine (50mg of Lugol’s) plus 200 mcg selenium daily. These I supplement because of their vital importance to thyroid and immune function;
  3. 3 mg LDN (low dose naltrexone) every other day to further increase immunity. LDN resources are listed below [32][33][34][35][36];
  4. Avoiding mercury and other endocrine disruptors. When I removed 9 amalgams (mercury), my TPO antibodies increased for 3 months and took another 6 months to return to previous values. I also avoid fish that have high and medium concentrations of mercury. Cod consumption increased my TPO antibodies;
  5. 1g of vitamin C daily. Since it seems to confer some protection against heavy metal thyroid disfunction [37], improve thyroid medication absorption [38] and there is some evidence that it could improve a defective cellular transport for iodine [39];
  6. Donating blood 2 to 3 times per year. In men, high levels of iron seems to impact thyroid function [40].

Final Thanks

I would like to make a special thanks to Paul Jaminet for giving me the opportunity to write this essay, for gathering many, many papers for me, and for having the patience to revise both posts and suggest many changes that made the text clearer; and to Emily Deans who kindly sent me one key study that Paul could not get.

References:

[1] Dr Datis Kharrazian. Iodine and Autoimmune Thyroid — References.  http://drknews.com/some-studies-on-iodine-and-autoimmune-thyroid-disease/.

[2] Marino MA et al. Urinary iodine in patients with auto-immune thyroid disorders in Santo André, SP, is comparable to normal controls and has been steady for the last 10 years. Arq Bras Endocrinol Metabol. 2009 Feb;53(1):55-63. http://pmid.us/19347186.

[3] Yoon SJ et al. The effect of iodine restriction on thyroid function in patients with hypothyroidism due to Hashimoto’s thyroiditis. Yonsei Med J. 2003 Apr 30;44(2):227-35. http://pmid.us/12728462.

[4] Kasagi K et al. Effect of iodine restriction on thyroid function in patients with primary hypothyroidism. Thyroid. 2003 Jun;13(6):561-7. http://pmid.us/12930600.

[5] Gribble GW. The natural production of organobromine compounds. Environ Sci Pollut Res Int. 2000 Mar;7(1):37-47. http://pmid.us/19153837.

[6] Zhang ZW et al. Urinary bromide levels probably dependent to intake of foods such as sea algae. Arch Environ Contam Toxicol. 2001 May;40(4):579-84. http://pmid.us/11525503.

[7] Kawai T, Zhang ZW et al. Comparison of urinary bromide levels among people in East Asia, and the effects of dietary intakes of cereals and marine products. Toxicol Lett. 2002 Aug 5;134(1-3):285-93. http://pmid.us/12191890.

[8] Leblanc C et al. Iodine transfers in the coastal marine environment: the key role of brown algae and of their vanadium-dependent haloperoxidase. Biochimie. 2006 Nov;88(11):1773-85. http://pmid.us/17007992.

[9] van Netten C et al. Elemental and radioactive analysis of commercially available seaweed. Sci Total Environ. 2000 Jun 8;255(1-3):169-75. http://pmid.us/10898404.

[10] Hou X et al. Iodine-129 in human thyroids and seaweed in China. Sci Total Environ. 2000 Feb 10;246(2-3):285-91. http://pmid.us/10696729.

[11] Toh Y et al. Isotopic ratio of 129I/127I in seaweed measured by neutron activation analysis with gamma-gamma coincidence. Health Phys. 2002 Jul;83(1):110-3. http://pmid.us/12075675.

[12] Miyashita S, Kaise T. Biological effects and metabolism of arsenic compounds present in seafood products. Shokuhin Eiseigaku Zasshi. 2010;51(3):71-91. http://pmid.us/20595788.

[13] Cleland B et al. Arsenic exposure within the Korean community (United States) based on dietary behavior and arsenic levels in hair, urine, air, and water. Environ Health Perspect. 2009 Apr;117(4):632-8. Epub 2008 Dec 8. http://pmid.us/19440504.

[14] Chong W, Shit Xg, Teng WP, et al. Multifactor analysis of relationship between the biological exposure to iodine and hypothyroidism. Zhongua Yi Za Zhi. 2004 Jul 17:84(14):1171-4. http://pmid.us/15387978.

[15] Tong YJ et al. An epidemiological study on the relationship between selenium and thyroid function in areas with different iodine intake. Zhonghua Yi Xue Za Zhi. 2003 Dec 10;83(23):2036-9. http://pmid.us/14703411.

[16] Karita K et al. Comparison of selenium status between Japanese living in Tokyo and Japanese brazilians in São Paulo, Brazil. Asia Pac J Clin Nutr. 2001;10(3):197-9. http://pmid.us/11708308.

[17] Thorling EB et al. Selenium status in Europe–human data. A multicenter study. Ann Clin Res. 1986;18(1):3-7. http://pmid.us/3717869.

[18] Mengüba? K et al. Selenium status of healthy Turkish children. Biol Trace Elem Res. 1996 Aug;54(2):163-72. http://pmid.us/8886316.

[19] Hincal F. Trace elements in growth: iodine and selenium status of Turkish children. J Trace Elem Med Biol. 2007;21 Suppl 1:40-3. http://pmid.us/18039495.

[20] Fordyce FM et al. Selenium and iodine in soil, rice and drinking water in relation to endemic goitre in Sri Lanka. Sci Total Environ. 2000 Dec 18;263(1-3):127-41. http://pmid.us/11194147.

[21] Alsayed A et al. Excess urinary iodine is associated with autoimmune subclinical hypothyroidism among Egyptian women. Endocr J. 2008 Jul;55(3):601-5. Epub 2008 May 15. http://pmid.us/18480555.

[22] Strieder TG et al. Prediction of progression to overt hypothyroidism or hyperthyroidism in female relatives of patients with autoimmune thyroid disease using the Thyroid Events Amsterdam (THEA) score. Arch Intern Med. 2008 Aug 11;168(15):1657-63. http://pmid.us/18695079.

[23] Stuckey BG et al. Low urinary iodine postpartum is associated with hypothyroid postpartum thyroid dysfunction and predicts long-term hypothyroidism. Clin Endocrinol (Oxf). 2011 May;74(5):631-5. doi: 10.1111/j.1365-2265.2011.03978.x. http://pmid.us/21470286.

[24] American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. https://www.aace.com/sites/default/files/hypo_hyper.pdf.

[25] Vanderpas JB et al. Selenium deficiency mitigates hypothyroxinemia in iodine-deficient subjects. Am J Clin Nutr. 1993 Feb;57(2 Suppl):271S-275S. http://pmid.us/8427203.

[26] Contempré B et al. Effect of selenium supplementation on thyroid hormone metabolism in an iodine and selenium deficient population. Clin Endocrinol (Oxf). 1992 Jun;36(6):579-83. http://pmid.us/1424183.

[27] Contempré B et al. Effect of selenium supplementation in hypothyroid subjects of an iodine and selenium deficient area: the possible danger of indiscriminate supplementation of iodine-deficient subjects with selenium. J Clin Endocrinol Metab. 1991 Jul;73(1):213-5. http://pmid.us/2045471.

[28] Benvenga S et al. Homologies of the thyroid sodium-iodide symporter with bacterial and viral proteins. J Endocrinol Invest. 1999 Jul-Aug;22(7):535-40. http://pmid.us/10475151.

[29] Wasserman EE et al. Infection and thyroid autoimmunity: A seroepidemiologic study of TPOaAb. Autoimmunity. 2009 Aug;42(5):439-46. http://pmid.us/19811261.

[30] Tozzoli R et al. Infections and autoimmune thyroid diseases: parallel detection of antibodies against pathogens with proteomic technology. Autoimmun Rev. 2008 Dec;8(2):112-5. http://pmid.us/18700170.

[31] Neve J. Clinical implications of trace elements in endocrinology. Biol Trace Elem Res. 1992 Jan-Mar;32:173-85. http://pmid.us/1375054.

[32] David Gluck, MD. Low Dose Naltrexone information site. http://www.lowdosenaltrexone.org/.

[33] LDN Yahoo Group. http://groups.yahoo.com/group/lowdosenaltrexone/.

[34] LDN World Database. Where LDN users share their experience with various diseases. http://www.ldndatabase.com/.

[35] Those Who Suffer Much Know Much. A colection of LDN users testimonies. http://www.ldnresearchtrustfiles.co.uk/docs/2010.pdf.

[36] Elaine A. More. The Promise Of Low Dose Naltrexone Therapy: Potential Benefits in Cancer, Autoimmune, Neurological and Infectious Disorder. http://www.amazon.com/Promise-Low-Dose-Naltrexone-Therapy/dp/0786437154.

[37] Gupta P, Kar A. Role of ascorbic acid in cadmium-induced thyroid dysfunction and lipid peroxidation. J Appl Toxicol. 1998 Sep-Oct;18(5):317-20. http://pmid.us/9804431.

[38] Absorption of thyroid drug levothyroxine improves with vitamin C. The Endocrine Society. News Room. http://www.endo-society.org/media/ENDO-08/research/Absorption-of-thyroid-drug.cfm.

[39] Abraham, G.E., Brownstein, D.. Evidence that the administration of Vitamin C improves a defective cellular transport mechanism for iodine: A case report. The Original Internist, 12(3):125-130, 2005. http://www.optimox.com/pics/Iodine/IOD-11/IOD_11.htm.

[40] Edwards CQ et al. Thyroid disease in hemochromatosis. Increased incidence in homozygous men. Arch Intern Med. 1983 Oct;143(10):1890-3. http://pmid.us/6625774.

 

Leave a comment ?

316 Comments.

  1. I’ve read that regular blood tests don’t properly measure Mg. The body apparently can maintain good levels in the serum, and has to to keep us alive, without there being enough in the cells. There seem to be a few different tests for measuring cellular Mg., but never having had one done, I don’t know much about them.

  2. I see in the 3rd abstract, that cellular Mg. is affected by T4. According to Guy Abraham, the combination of iodine/iodide, and Mg., stop the damage being done to the thyroid by H2O2 and other oxidants, to cure Hashimoto’s. Since serum Mg and cellular Mg are 2 different values, maybe the cells need higher Mg for a time until the damage being done is stopped.

    “Combined magnesium and io-
    dine/iodide deficiency based on the concept of orthoio-
    dosupplementation are the basic factors involved in the
    oxidative damage caused by excess H2O2 and reactive
    oxygen species. If this proposed mechanism is valid,
    orthoiodosupplementation,30 combined with magnesium
    intake between 800-1,200 mg/day, a daily amount this
    author recommended 21 years ago98 for magnesium suf-
    ficiency, should reverse autoimmune thyroiditis. This
    nutritional approach is also effective in Graves’ autoim-
    mune thyroiditis as previously discussed.” Dr. Guy Abraham

  3. Virginia,

    I could find only one human study about magnesium levels on serum and erythrocyte in hypothyroidism and hyperthyrodism:

    http://www.ncbi.nlm.nih.gov/pubmed/2810922

    Full text here:

    http://www.journalarchive.jst.go.jp/jnlpdf.php?cdjournal=internalmedicine1962&cdvol=28&noissue=4&startpage=496&lang=en&from=jnlabstract

    Both, serum and erythrocyte magnesium, had negative correlations with T3, T4 and free T4.

  4. Dr. Abraham proposes that excess H2O2 is produced in response to high cytosolic calcium. Perhaps the body takes in all the Mg it can to counter the excess Ca. Maybe the thyroid cells themselves need to be checked for Mg content. Also, maybe just because the Mg is high in the serum and erythrocytes, it’s because the thyroid needs a lot to balance the Ca. I guess short of doing my own lab work, I feel like Dr. Abraham has studied the subject more than anyone, and I trust his conclusions.

  5. Hello,

    I have been following and enjoying your blog for some months now. (I bought the book, too!)

    About two weeks ago, I had my thyroid levels checked. The results:

    TSH = 4.54
    T3 free = 2.7
    T4 free = 1
    Thyroperox AB = >1300

    (I’m not sure what thyroperox is… it was written on the lab work I got in the mail.)

    I was hoping I could ask you three things:

    1. Does this mean I have Hashimoto’s? The nurse said the normal level for antibodies was 0 to 60, but she never used the word, “Hashimoto’s.” I’m not sure if there is a certain level of antibodies beyond 60 one must have in order to be diagnosed with Hashimoto’s.

    2. I’ve been taking most of the supplements you recommend (not iodine—I just wasn’t sure about that one), but I’ve been having a weird reaction to the copper. About five minutes after swallowing a pill, I have a very intense urge to vomit. It goes away fairly fast, but it’s unsettling to say the least. I have discovered that if I quarter the pill, I do not have these symptoms. Do you have any thoughts on why this might be happening?

    3. What do you recommend, generally, for a next step? The family nurse practitioner I saw consulted an endocrinologist, and the endocrinologist recommended a “wait and see” approach. After I balked at this, (I haven’t been feeling well lately—the couch is my new best friend), the nurse put me on 12.5 mcg of Levothyroxin (1/2 grain) and said come back in two months. So far, I haven’t noticed any effects from the medicine, but it’s only been two weeks.

    Thanks for much for any advice you can give!
    Lynn

  6. Hi Lynn,

    Yes, it does sound like Hashimoto’s. Thyroid peroxidase (TPO, http://en.wikipedia.org/wiki/Thyroid_peroxidase) antibodies, plus TSH and symptoms, are the main criteria for diagnosis.

    Can you tell me what the normal reference ranges were for free T3 and free T4?

    I would stop taking the copper. One symptom of copper excess is nausea or vomiting. It could be you have an environmental source of copper (copper water pipes?). Is your water treated? You might want to supplement zinc for a while in case you have a zinc deficiency.

    12.5 mcg levothyroxine is a very small dose.

    One of the first things to do is try to find the right dose of hormone. You can try higher doses of the levothyroxine and see if they make you feel better. You could try every 25 mcg up to 100 mcg/day and judge what feels best.

    I would start at least a low dose of iodine, say 500 mcg. It’s best to rule out deficiency as a possibility.

    It sounds like your doctors aren’t too helpful. Did you tell them you’ve been tired and spending time on the couch? That sounds like someone who needs more than 12.5 mcg. Did they do anything to check for possible contributing factors? Iron levels? Do you have any signs of infection?

    Best, Paul

  7. Thanks for responding so quickly!

    I will stop taking the copper. I don’t know if I have copper pipes—I will check that out—and add zinc.

    Yes, I told the nurse that I have become increasingly fatigued. I have also gained about 10 pounds in the last four months alone, and my eyelids are always puffy now. (I told her this, too.) But I also told her I was having heart palpitations at night, (still true) which is why the nurse said they didn’t want to give me a higher dose. (I have since looked up Hashimoto’s disease, and I feel like this is a common enough symptom, so I’m not sure I understand the reasoning, but that was what I was told.)

    No, they didn’t check iron levels. Signs of infection? Hmm. Well, actually, after I started following the diet advice in the book, I feel like my health improved somewhat — brain fog has been MUCH better. But, at the same time, the fatigue has been getting much worse. So I guess I’m not really sure.

    I’m sorry to write that I don’t remember the normal range for T3 and T4–it wasn’t on my lab report. I do remember she said the bottom range for T4, I believe, was .7. Both the free T3 and T4 were in the normal range, but close to the bottom.

    Sounds like I should find another doc?

    Thanks again!!

  8. Lynn,

    “Sounds like I should find another doc?”

    You can ask for a better doc in some lists, like:

    http://health.groups.yahoo.com/group/NaturalThyroidHormones/
    http://health.groups.yahoo.com/group/iodine/

    But, primarily, learn as much you can about Hashimoto’s, KEEP the PHD diet with liver, eggs, broth, etc, FOLLOW PDH book chapter 4 tips on how to enhance immunity. Discover and fight/avoid as much as you can what are causing your autoimmunity (infections and endocrine disruptors, like bromide, fluoride, heavy metals – amalgams? eat too much seafood? -, plastic chemicals, etc).

    You have the luck to have only subclinical hypothyroidism, so recover is allways a possibility. A good doctor may have its usefulness, but your own knowleadge is key.

    Some recommended books:

    Dr. Brownstein Iodine and Thyroid books:
    https://www.drbrownstein.com/homePage.php

    Mary J. Shomon, Living Well With Hypothyroidism:
    http://www.amazon.com/Living-Well-Hypothyroidism-Doctor-Revised/dp/0060740957/ref=sr_1_1?ie=UTF8&qid=1307272905&sr=8-1

    Mary J. Shomon, Living Well with Autoimmune Disease:
    http://www.amazon.com/Living-Well-Autoimmune-Disease-You-That/dp/0060938196/ref=pd_bxgy_b_img_b

    Donna J. Nakazawa, The Autoimmune Epidemic:
    http://www.amazon.com/Autoimmune-Epidemic-Donna-Jackson-Nakazawa/dp/0743277767/ref=sr_1_1?s=books&ie=UTF8&qid=1307272945&sr=1-1

    Best,
    Mario.

  9. Hi Lynn,

    It does sound to me like some sort of infection. Brain fog and fatigue are both signs of very high immune activity, either due to food sensitivities or the breakdown/die-off products of infectious pathogens.

    I would at a minimum pursue probiotics and fermented vegetables (L reuteri is known for reducing gut leakiness, and improving the array of species can help reduce food sensitivities and clear gut infections).

    You may find that detoxification aids reduce symptoms. For water-soluble toxins, salt and water; for fat-soluble toxins, charcoal, bentonite clay, chlorella, or cholestyramine.

    You can find the right thyroid hormone dose experimentally. If you go a little too high briefly it won’t do lasting harm.

    More specific symptoms and lab tests might help identify pathogens.

    You have to be the judge whether your doctor is helping you or not. They don’t sound very knowledgeable, but if they are cooperative then you can become knowledgeable and teach them how they need to treat you. If they are un-knowledgeable and un-cooperative, then I would get a new doctor.

    Best, Paul

  10. Thanks Mario and Paul!

    I will start working on this, taking all of your suggestions into account!

    Much appreciated,
    Lynn

  11. Sorry to bother everyone here again. I am at a loss for what to do. I saw my Dr. yesterday (he is an MD and focuses in Natural Health)

    He wants me to take a high B-Complex for the adrenals but I feel there is so much more that could be done but maybe I am wrong? He did state that my diet is excellent so there is no room for improvement there.

    He also said he would recommend Armour Thyroid for me. I did not take a prescription for it because I feel so confused. I asked him based on the numbers from the tests which I put in another post if he thought I was hypothyroid or this was why I could not lose weight and he said no. He said something about dividing my T3 into my reverse T3 and coming up with a number 4 which is good??? I asked him about the TSH, which according to the PHD book and other sources is high for a functional range and he said TSH means nothing to him. Even after saying all that he still recommended the Armour?

    I want to lose weight but not at the expense of not finding out and truly fixing whatever is wrong. I am tired all the time anymore (not lay down and fall asleep tired but my body feels tired. I hope that makes sense?

    My progesterone is low also and since the adrenals, thyroid and hormones are all interconnected I don’t which to be most concerned about?

    I have just started to take a drop of Iosol daily and will not double the dose for a month per the PHD and I started with the Selenium a couple weeks ago.

    The only other option I have is to try to get in with an Endo in this area that I believe has taken training by Dr. K but he is going to be very expensive as he does not accept health insurance and I am not sure that our budget can take it. I also am somewhat put off by the fact that he says you must agree to buy all supplements through his office or he will refuse to treat you further. I spend a lot of money on good quality supplements and alternative practitioner’s but to say this so blatantly is a turn off for me. But if it is best than I shall go.

    I really don’t know what else to do and I just can’t seem to make any decision on this?

  12. @ Traci, Why not do a trial of the Armour for a couple months?

  13. Hi everyone,

    I’m wondering if others might shed some light on my recent experience. After taking iodine for a couple of days (500 mcg to start with), along with some selenium, I developed a headache, dizziness, stiff joints, and some general weakness. This is after feeling an initial burst of energy upon introducing iodine.

    Has anyone else had this experience?

    I’m in my twenties and have a history of feeling tired and generally lacking positive emotion. Oh and skin disorders.

    Thanks

    Matthew

  14. Matthew,

    Undoubtedly your symptoms are bromide related, look here:

    http://breastcancerchoices.org/bromidedetoxsymptomsandstrategies.html

  15. Hi, Matthew,
    I went through several weeks of similar symptoms when starting iodine. Actually according to Dr Abraham, too small an amount is what caused people to develop goiters and thus gave iodine a bad rap. I started with 1 Iodoral tab and worked up to 50 mg a day. I did an iodine loading test last year, and was still a bit low, so continued with the 50 mg (4 tabs) until last month when I cut back to 25 mg. I mostly don’t need thyroid meds, now, but with stress and what not get into a bit of a slump and take Armour for a while. I get regular blood tests. I have Hashimoto’s, and the first time I was tested the antibody count was very high (600’s). The next test it was 127. I’m going to have another test next month. Some people need T4 for life, and some produce enough on their own for much of the time. For your fatigue, emotion and skin, you might look into the methylation cycle. It requires certain foods that a lot of young people might not get enough of e.g. dark leafy greens for folate and sulfur from broccoli and garlic, and methionine from fish, eggs, and poultry. You also need B6 and B12.
    Best wishes for good health.
    Virginia

  16. Hi Traci,

    B vitamins is probably good advice, although maybe not niacin. I usually recommend getting B vitamins individually, even though it requires more pills.

    I also would recommend Armour Thyroid if you have hypothyroid symptoms. Replacement hormones will make the rest of your body healthier. It won’t heal the thyroid, but it will give you time to heal that by natural means. It generally takes time to heal the thyroid, and you shouldn’t suffer unnecessarily in the meantime.

    As Kate mentions, you can do a trial and see if you like it.

    These two recommendations are very conservative and highly likely to help.

    I don’t think it’s a question of which to be most concerned about. It’s more about which you can have useful therapies for. Replacement thyroid hormone helps, replacement adrenals usually doesn’t, so start with the thyroid.

    I can never remember what the dose of iodine is in a drop of Iosol. Be careful, it might be high enough to have negative effects on the thyroid as a starting dose. I would try the Armour thyroid first, experiment to find the optimal dose, get stable, then try a controlled low dose of iodine and see if this lets you reduce your Armour dose.

    I think it’s best to proceed gradually and systematically trying conservative approaches first. Your body needs time to heal and you want to do the easy fixes first and see how far they take you.

    Best, Paul

  17. Hi Matthew,

    Possible factors include thyroid reactions, bromine, and infections. In severe deficiency conditions the thyroid can have a strong response to even very small doses. Also bromine can produce big responses to small doses. Die-off from an infection is probably not likely to be a major cause of symptoms on only 500 mcg/day, but might be a contributing factor.

    I would first of all make sure other nutrients are in good shape, eg copper – if there is a copper deficiency then you could have dramatic thyroid responses to iodine.

    If those are good then I would continue the low-dose iodine, and try detox steps — salt and water for bromine, bentonite clay, charcoal, or chlorella for fat-soluble toxins such as are produced by dying pathogens.

    You may not be able to take high doses of iodine for a long time, but I would interpret these symptoms as signs that the iodine is having good effects. If you didn’t need iodine, you wouldn’t react strongly to a small dose.

    Best, Paul

  18. I’m enjoying this series, but get confuseder the more I read. 🙂 I’m a post-menopausal female who has lost 110 pounds following a primarily low carb diet, but still have a good 90 to go and have been stalled for almost 2 years in my weight loss efforts now. in 2006 I was diagnosed as type 2 diabetic which began my weight-loss journey. I was also diagnosed with Hashimoto’s the exact same month that my weight loss came to a dead halt(fall 2009). I’ve been struggling with that for almost 2 years now too. I was originally put on synthetic levothyroxine (Levoxyl) which from all my reading is not at all a good choice for most people, and certainly didn’t alleviate any of my symptoms, or lower my cholesterol – which was actually my primary symptom. Finally found a holistic nurse practitioner three weeks ago who is willing to let me go on Armour (doctors I saw all utterly refused outright to consider it, and only wanted to put me on STATINS – the Drug of the Devil IMHO).

    So I’ve been on that three weeks now, currently at 105mg Armour daily. But the whole *supplement* issue has me in a tizzy. I keep seeming to need to add more and more and more supplements as I get told I need certain things. Currently supplementing with D3, K2, probiotics, ashwangandha, milk thistle, vitamin E, vitamin C, zinc, melatonin, C0Q10, chromium. My recent blood tests showed that my ferritin level was WAY low (23) and need to be up around 70 for optimal thyroid function, so now I’m supplementing with iron also. Lastest thyroid numbers shows TSH 2.38 (range 0.4-4.5), Free T4 2.2 (0.8-1.8), free T3 3.5 (2.3-4.2), TPO AB 75 (<35). The NP feels my TPO AB is as low as it is because I follow a gluten-free diet, ahe she sees a lot of correlation between gluten intake and high antibodies. I worried about low B12 also, but mine was actually sky-high at 1952 (range 200-1100).

    Now I read about needing selenium, iodine, copper. I'm already spending hundreds every month on supplements, and being unemployed for just over a year now the financial drain just can't go on. I'm trying to find out what I can do with FOOD. I mean I have to eat after all anyway, so want to maximize my food intake for nutritional density. I'm trying to follow a more-or-less PHD plan now, and waiting for my dinner to cook – shrimp florentine over coconut rice, yum.

    I eat pastured eggs I buy from an Amish farmer, raw cream for my coffee, grass-fed organic beef. I am trying the best I can. But it would be nice to get my health optimized, and start to lose some weight again.

    Oh,

  19. Hi Debbie,

    It definitely should be possible to reduce the cost of supplements. We probably spend about $30-40/month.

    CoQ10 is good but very expensive, maybe not worth it. Vitamin E is best from food. I don’t know the basis for the ashwangandha. I would use glutathione or NAC in place of milk thistle. Melatonin is for your sleep? Zinc is probably unnecessary if you take a multivitamin. D3 is unnecessary if you get enough sunlight.

    Definitely fixing iron, and eating beef liver for copper, should help.

    Are you still diabetic? Do you have hypothyroid symptoms?

    Best, Paul

  20. Debbie,

    I agree with Paul. I think you have spending too much money in supplements. I would cut almost everything, except vitamin C and D (if you can get enough sunlight) and try to get what you need from diet.

    The best probiotic I know of is dirty:

    http://coolinginflammation.blogspot.com/2011/06/contagious-health.html

    Iodine would also help you with your diabetes.

    http://www.iodine4health.com/disease/diabetes/flechas_diabetes.htm

    Good luck!

    Mario.

  21. Hi guys – I’m back with a question regarding my mother’s labs:
    antimicrosomal antibodies 49.7 (<60)
    anti thyroglobulin 28.4 (<60)
    Ft3 3.2 (2.2-4.0)
    Ft4 1.3 (.8-1.5)
    rt3 H439
    tsh 2.995 (.350-5.00)

    I have already established she has a nasty RT3 ratio of 7.2, but what are your thoughts on the antibodies?

    thanks in advance for your thoughts!
    Miriam

  22. They are good … no Hashimoto’s. Is that her doctor’s interpretation?

  23. No it isn’t, but I was concerned because of the difference in upper limits between labs. My lab UL is <20 for TPOAb, but her's is <60.

    It's ok for someone to have antibodies, but not be hashi's? I'm confused again 🙁

  24. Everybody has antibodies at some level. Most people with Hashimoto’s are far above the normal range. Levels like 700 and higher are not uncommon. Different labs have different test procedures which lead to different results, the ranges are normed differently for each lab. I think you can rule out Hashimoto’s, though I guess the antibody titers can be variable and if you wanted absolute certainty (unnecessary in my view) you might want a second measurement at some future date.

  25. Thank you!

  26. Hi Paul – I was just wondering what you think. I’ve been taking the copper (we talked about a few weeks ago) and every time I take it, after about 5 minutes I have an overwhelming sensation like I’m going to throw up, and then I have a really STRONG sneeze, and then the whole thing goes away. It’s definitely the copper because it never happens any other time. Is this a normal reaction? Bad, good? Should I be doing something else when I take it?

    thanks
    miriam

  27. Paul,

    Thanks for your response. I guess I am just confused and frustrated because I do research which seems to contradict everything and leaves me not knowing what to do. For instance a thyroid site I have looked at states that my ratio of total T3 to RT3 is 3.7 (should not be below 10 according to that site) and since I do have adrenal problems (verified by saliva test- normal cortisol in the morning, depressed at noon and 4 and high at night) that I should only be on T3 to clear the excess RT3 and prevent further stress on the adrenals. But yet the Dr. says 4 ratio is good and still wants to prescribe Armour? Then to further complicate things my completely natural Dr.(chiro) which I have seen for 7 years says that I should concentrate fully on the adrenals and take ProgonB (progesterone levels are very low)

    I guess I am just afraid of taking the Armour and doing further damage. The Iodoral really seemed to set things off. I do have some hypothyroid symptoms- fatigue but it comes and goes, gain weight very easily despite what I eat, cold etc but I do not have all of them (hair loss, eyebrows constipation) and the problem is some of them are the same symptoms for adrenals and low progesterone.

    So do you think the Armour would cause further problems with the thyroid and/or adrenals? And what would be your recommendation on the ProgonB?

    Thanks,
    Traci

  28. Here’s a little follow-up on Iodoral: After starting very slowly last September (I’m up to half a tablet daily now and plan on upping that to a full tablet in the near future), I’m happy to report that my eyebrows seem to have filled in.

  29. Hi Traci,

    This is a little beyond my expertise, but here’s my understanding.

    I guess the issue is whether reverse T3 is inactive in regard to T3 function (it does have its own functions, and it blocks T4 to T3 conversion) or blocks T3 receptors. I’ve seen both statements. If rT3 is inactive then having more doesn’t do you harm. The T4 in Armour will be converted some to rT3 which won’t do you harm and some to T3 which will help. The body will produce less T4 to make up for the supplemental T4. So the Armour would be OK, especially if TSH is high. On the other hand if rT3 blocks T3 then you’re right, more T4 could be a problem.

    While some women are helped by progesterone, there’s more risk in sex hormone (and adrenal hormone) supplementation than in thyroid hormone supplementation. Also, I’m not sure what the basis for progesterone is in your case, as the hormones that have the most thyroid interaction (I understand) are adrenaline and cortisol. I don’t wish to make specific recommendations, but I would consider that a late resort after you’ve run out of other possibilities to try.

    The main question is what is the underlying condition that is producing the high rT3. This is usually due to chronic infection or stress that causes the body to want to conserve energy to fight the infection, repair wounds, etc. You should strive to be well nourished to prevent nutrient deficiencies / starvation as a reason for this. And try to diagnose the underlying condition and fix it.

    Iron deficiency can also cause high rT3, so you want to fix an anemia / iron deficiency if you have one.

    Best, Paul

    Hi erp,

    That’s great! I take one Iodoral a day myself. I’m glad you’ve been able to raise the iodine without adverse events.

    Best, Paul

  30. Paul,

    This is from the STTM site

    “But cortisol also plays an important role for you as a thyroid patient. Namely, cortisol works with your cell receptors to receive thyroid hormones from the blood to the cells.

    On the other side of the coin, low cortisol can result in high amounts of thyroid hormones to build in the blood, making your free T3 and/or free T4 labs look high in range with continuing hypo symptoms, or causing hyper-like symptoms on doses of Armour which shouldn’t produce those symptoms. The latter can include anxiety or nervousness, light-headedness, shakiness, dizziness, racing heart, sudden weakness, nausea, feeling hot, or any symptom which seems like an over-reaction to desiccated thyroid, but are in reality low cortisol symptoms, or a mix of high and low in the early stages of sluggish adrenals. Low cortisol can also keep you hypothyroid with hypo symptoms.

    The use of T3-only: Many patients with ongoing health issues, or those with adrenal fatigue, can find themselves with too-high levels of Reverse T3. Making RT3 is a natural way for your body to clear out excess T4, so you natural convert the excess T4 to RT3. But with lingering problems or adrenal fatigue, you can make far too much, which in turn stresses your adrenals, besides keeps you hypo. The solution is to be on T3-only, i.e. no T4 in the treatment, to remove the excess RT3. And until you identify and correct any other lingering issues–low B12, low ferritin, undertreated adrenal fatigue, gluten intolerance, etc–you’ll need to stay on T3 for awhile. Multi-dosing with T3 is very important, since you will have no conversion from T4 to depend on.”

    I did ask my Dr. about a ferritin test and he said my albumin was fine and that is directly related to iron? But it sounds as though I should have that tested and possibly b-12 also? I started having major bloating, gas and feeling of undigested food about a year ago. ACV and HCL help along with Pancreatin but I still have episodes.

    Also, as much as I dread it and the cost I think I will have another stool test done to confirm the h.pylori and histoylitica are gone.

    I do not eat or gluten or casein so that is not an issue. As much as I hate to say it I really think it is cortisol/adrenals. My chiro has been telling me this for years and I am easily stressed. Really working on that one. I did purchase a round of Dr. Wilson’s treatment for adrenal fatigue and am going to give that a go and really try to work on stress levels although we all know that is easier said than done.

    In the meantime I may give the Armour a try, he only prescribed a 30 mg tablet

  31. Hi Traci,

    I think T3 only is a sensible strategy, but I’m still not sure that having some T4 with it is a problem. Your quote says that rT3 stresses the adrenals, which is another pathway for me to look into.

    I think a ferritin test would be prudent, especially if you are menstruating. B12 you could test for, or just try supplementing 500 mcg/day, which shouldn’t do any harm.

    Bloating and gas are clear signs of gut dysbiosis so that would be a more obvious thing to work on than the adrenals. I’m not sure I’d spend money on the stool test until you’ve exhausted gut therapies.

  32. Good afternoon, very interesting article, thank you. I have a hard time with the scientific stuff, but followed pretty well!

    I have low temp from an illness over a year ago and a 3 week stay in intensive care. My hair all started falling out when I got out of the hospital, someone suggested thyroid/iodine, 3 days after starting iodine my hair stopped falling out. I was almost bald… needless to say, I’m thrilled.

    I currently take about 30-35 mgs of iodine a day, lugol’s. We also take 200mcg selenium a day — this is the first I’ve heard of the connection so that’s good to know. If I take more, I get definite bromine-illness symptoms — feel like I have the flu, depressed, etc. I do salt loading and feel much better within an hour or so. When this happens, I stay off the iodine for a couple of days, then go back on. Not sure if this is the right approach… maybe I should stick it out, do more consistent salt-loading and try to get the bromine all out.

    BUT here’s my real question: I believe my son might have hyperthyroid. Some believe iodine supplementation is good for that. May worsen it for awhile, but eventually will regulate the thyroid. I’ve done searches galore and good info on hyperthyroid is slim. Do you know any place I can get good info on this and iodine supplementation?

    I’m a member of several yahoo groups on iodine and have looked on curezone and earthclinic, the breastcancersite.org (think that’s the name), stop the thyroid madness, etc. and nothing concrete.

    I’m also the WAPF chapter leader for Lexington KY so know those ropes as well.

    Thank you for any and all info. I appreciate it.

  33. Hi Sally,

    Has your son been tested? That should be the first step.

    I think that Mary Shomon, who writes at http://thyroid.about.com, is one of the most reliable sources on thyroid disease around. She’s written about 20 articles on hyperthyroidism which can be found here: http://thyroid.about.com/od/hyperthyroidismgraves/Hyperthyroidism_Graves_Disease_Overactive_Thyroid_Condition.htm.

    One thing I would advise is: do NOT do radioactive iodine therapy.

    My impression is that iodine supplementation can be helpful against hyperthyroidism. Certainly iodine deficiency tends to cause it, and the incidence of hyperthyroidism around the world decreases as iodine intake increases. Iodinization of salt was introduced in large part to reduce rates of hyperthyroidism. See, eg, http://www.ncbi.nlm.nih.gov/pubmed/21513914.

    However, there are always issues of adaptation, and usually a short-term negative response, when adding iodine, and in hyperthyroidism these can be significant. I think experiences of some of the doctors who have treated hyperthyroidism with iodine, like Dr David Brownstein, might be helpful. Here is a search of his site for hyperthyroidism: http://www.google.com/search?q=site%3Ahttp%3A%2F%2Fdrdavidbrownstein.blogspot.com%2F+hyperthyroidism. He believes bromine toxicity can cause hyperthyroidism, and uses cats as evidence.

    I’m not personally knowledgeable about treatment of hyperthyroidism but hopefully these links will give you something to think about. Please let me know how your son’s case develops.

    Best, Paul

  34. Thank you, Paul. I will check out all the information. I really appreciate the direction! He does the salt loading sometimes and always feels better afterwards… he’s 19 and playing along with more of mom’s crazy ideas is sometimes difficult…

    I will keep you posted.

  35. Hi Miriam,

    Somehow I forgot to reply to your comment (http://perfecthealthdiet.com/?p=3650#comment-24873). Nausea is a symptom of copper excess, so perhaps you don’t need it. I would stop the copper supplements, but eat beef liver once in a while to get some copper.

    Best, Paul

  36. Hi Paul- the nausea doesn’t stick around (like when I’ve taken zinc in the past). It’s a really quick wave of it ALWAYS followed by a sneeze. This morning, for example, it didn’t do it and I think it was because my tummy was busy with a protein shake. Maybe I’ve taken it on too little food, or maybe I need less?

  37. Paul,

    It seems as though the last month or so the fatigue has gotten much worse and I just realized that about a month ago I stopped taking L-Tyrosine. I used to take 2 500mg caplets first thing in the morning. It also really helped with my anxiety. Do you think this is why I am more fatigued now? Should I go back on it or will the Armour be enough? Also, would that have had any effect on my thyroid panel numbers or am I just grasping at straws here?

  38. Hi Miriam,

    It’s almost always better to take minerals with food, and if there’s toxicity it seems like it’s only momentarily in your digestive tract, but I wonder if this may not be a warning that you have enough. I haven’t heard of this symptom before, it’s interesting.

    You don’t have any allergic symptoms on contact to copper, do you?

  39. Hi Traci,

    If it helped then I’d go back on it.

    If you’re low in tyrosine you might be low in other amino acids too. Perhaps you should eat more protein?

  40. No, but the dr who read my hair analysis is convinced that I have hidden copper because I have hypothyroid, mercury and candida. It may be the case, however I’ve also read a lot about how you can be copper toxic, but deficient at the same time. The hair alaysis is low, and I have a high zinc:copper ratio. You and I got talking about the whole thing because of my difficulty raising the ferritin levels. I’m not experiencing any other symptoms per se, but maybe I can stop for a week and see if I feel a difference. It’s just if copper is what is going to raise my iron, even if I have toxic stores of it that my body can’t otherwise use, then maybe I need just a little to clear things out?

  41. Hi Miriam,

    Ah, now I remember. I guess I would continue taking copper, but with food. But I would favor beef or lamb liver as a source.

  42. oh gosh – liver. Hmm. Well, I guess I will consult my mother-in-law in France, because if she doesn’t have a palatable recipe for liver I don’t think anyone will. My parents raised me a strict vegetarian so any bite of meat is a struggle for me, but my husband on the other hand, happily eats boar, duck, pheasant, frogs, snails, goose…..and seems to be better off for it. He just asked me to make liver salad and now I’ll have to eat crow!

  43. I don’t think crow is as healthy as liver!

  44. Ok, somehow I knew you were going to say that.

  45. Hey Paul,

    I’m still not sure exactly what supplements I should be taken, and what food to avoid beside gluten,

    I read that people with autoimmune disease should eliminate eggs, dairy and nightshades as well , do you think it’s a necessary step in treating hashimoto’s?

    Regarding the supplements,
    Are the B-vitamins, Choline, NAC and detoxification aids are also needed to be taken in this case?

    Thanks!

  46. Hi Danny,

    It’s rarely necessary to eliminate eggs, dairy and nightshades. These only cause trouble when the gut is leaky, and usually you will have obvious gut symptoms to deal with. If you don’t have those, your Hashimoto’s is more likely due to wheat or infection.

    The B-vitamins are mostly tangential to Hashimoto’s and probably won’t have much effect, but might help and will do no harm. NAC is probably the most likely to help, as it helps against infections and also reduces oxidative stress which is implicated in Hashimoto’s. Choline can best be obtained from eggs and liver, but if you don’t eat those then supplementing is a good general practice. Of the B vitamins, B12 may be the most important, as deficiency can induce a lot of hypothyroid symptoms. This should be taken with B6.

    Detox aids – again this depends on the cause of your disease. Some chronic infections can produce a lot of die-off toxins and hypothyroidism simultaneously. If so you’ll probably have low-level systemic symptoms, eg skin complexion affected, fatigue, less deep sleep, etc. You can try out the detox aids to see if they help. I don’t know what the odds would be. Usually there are other symptoms besides hypothyroidism if they are going to help, but you don’t know until you try.

  47. Hi Paul,
    I have finally had a full thyroid panel done, could you take a look & see what you think please;

    previous TSH: 2.3 (13th Apr 2011)
    latest results; 22nd Jun 2011:
    TSH: 3.3
    FT4: 19 pmol/L (lab range 10-20)
    FT3: 4.4 pmol/L (lab range 3.5-6.0)
    Antibodies;
    Anti-Thyroglobulin(anti-Tg): <30 U/ml (lab range <60)
    Anti-Thyroid Peroxidase(anti-TPO): 54 U/ml (lab range <60)

    more info: I started taking Iosol on 9thJun2011 (12 days before the blood tests) averaging about 12mg per day.
    Iosol is approx 50% Iodine & 50% Iodide (from Ammonium Iodide).

    Also, would it be worth finding out my rT3 as well. I read somewhere that "Measurement of rT3 is also valuable in identifying sick euthyroid syndrome where active T3 is within normal range and rT3 is elevated".

  48. note on above; the measurement units are from an Australia lab, which probably differ from US labs.

    The TSH uses the same units (mIU/L).

  49. Hi Darrin,

    All of those look good except the TSH, but an elevated TSH isn’t surprising 12 days after starting 12 mg iodine.

    Given the recent change in iodine, the numbers won’t necessarily be reflective of thyroid status. It takes ~3-4 weeks to adapt to a new iodine dose.

    As you may know, I wouldn’t have recommended going from no iodine (as suggested in your 27 May comment) to 12 mg/day immediately. I recommend taking at least 6 months to reach that dose, with gradual increases from 500 mcg or so per day.

    rT3 – I don’t know. Do you have health problems or is this curiosity?

  50. “rT3 – I don’t know. Do you have health problems or is this curiosity?”…..a bit of both really. I still have hypo symptoms; dry skin, increased hair loss, sleep problems, low body temp.
    But none are getting worse, & (cross fingers) could be improving, since starting all the relevant PHD supps.

    My morning oral temp use to be all over the place; ranging from 96.7F to 98.1F. Whereas now it is much more stable, but still on the low side;97.0F-97.5F, but hopefully it is trending up.
    Any change to hair loss is harder to quantify, given that it could take approx 3 months for positive changes to flow thru.

    I’ll comment on the Iodine, Iosol, in the post below.

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