Episode 19: Medication And The Thyroid

 

The thyroid produces 85% of the T4 hormone in your body. In the liver, T4 is processed and converted to T3. T3 is our fat-burning hormone, which is a good thing. But if you’ve got too much T4 that’s not being properly converted or processed, you end up with a hormonal imbalance. In this episode Haylie Pomroy answer some of her community’s concerns about the thyroid, metabolism, and thyroid medication. Learn how you can promote a healthy metabolism while dealing with thyroid issues.

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Medication And The Thyroid

I wanted to know if you have any questions about the thyroid and how the thyroid works with the metabolism. In your Fast Metabolism Diet book, I consider it one of the metabolism superheroes. We have a great section that talks about the thyroid and reverse T3, T4, T3 and TSH. There's a lot about the thyroid that maybe sometimes we don't think about. We think if we can stabilize the TSH or we can have a normal T3 level that everything's fine with the thyroid. 

I had an interesting conversation with my mom while I was traveling. She has her PhD in Reproductive, Endocrinology as well as Chinese medicine. She was saying that one of the things that we do well in Western medicine is surgeries. There's an absolute in that aspect of science. If you fracture a bone, you can stabilize the bone and allow it to remodel. You can put a plate and screws in but when it comes to hormones, there's an ethereal or not tangible aspect of medicine. Endocrinology is a lot of balancing, rebalancing, re-establishing and supporting different areas of adaptation in the body. With the thyroid being such an important one, we say triple warmer.

If you think about the glandular like the pituitary gland up in the head that regulates a lot of the hormones. The thyroid and the parathyroid glands regulate a lot of the hormones, and the lower body, the ovaries and the testicles are adrenals and kidneys, which help regulate a lot of the hormones. The bone regulates. They're talking a lot about stress and stress hormones, adaptogenic hormones, estrogens and progesterone. The actual marrow of the bone will regulate a lot of the hormones.

The thyroid is an interesting one for a lot of reasons. One, it's the superhero. It is a big pivot point in the body and a big pivot point when we're talking about the metabolism of fats, complex carbohydrates and proteins. It's also misunderstood and oftentimes approached from a reductionistic perspective, which means it’s one myopic or one view of how to work with it. I'm not an endocrinologist. I’m not a doctor. I don't even play one on TV, but I will tell you that in my own body, I had to work a lot on hormones. I have experienced a lot of things that I will talk to you about and share with you. I've been fortunate enough to walk the journey with a lot of individuals that are dealing with hormone or endocrine issues.

What Works With Hashimoto’s Thyroiditis

We’ll get to some of that, but I want to get to your questions to start. We'll keep them topical on this post if you have more questions about hormones and the thyroid. Maybe you just want my perspective on what I've seen or experienced in the past with clients and being in practice as a partner, and my clients walking through different aspects of hormone balancing. The first question that we got is, “What foods can I incorporate that help with Hashimoto’s?”

You are probably hearing more and more about Hashimoto’s Thyroiditis or Hashimoto’s Disease. Just a couple of little things to clear up. One, it is real. I've had many clients from 10, 15, 20 years ago that have come back in tears and have said, “My endocrinologist says, ‘I don't believe in Hashimoto’s.’” A couple of iffy medical schools like Harvard, Johns Hopkin, Mayo Clinic, MD Anderson, and a few of those iffy, sketchy schools have whole departments that are dedicated to deal from an endocrine perspective with Hashimoto’s Thyroiditis.

Let's clear that quickly and have this agreement. If you've ever seen a practitioner or physician that says they don't believe in something, I always try to reframe it with, “You aren’t versed in it yet. If we choose to stay together as partners, you're going to be well versed in it because I'm going to bring stuff to the table that maybe you don't know about yet.” That's okay. That's why they call it the practice of medicine, the practice of nutrition, the practice of understanding or learning what’s going on in your body.

Hashimoto’s Thyroiditis is an autoimmune disorder. It is not necessarily a disease of the thyroid, but it is a disease that causes damage to the thyroid. There are two different ways to look at it and I'm going to distill it down a little bit because there's a whole lot of complexity and a lot of things with hormones that its homeostasis, it's not a constant. With Hashimoto's Thyroiditis, we typically look at anti-thyroid antibodies and thyroid peroxidase. One will go in and destroy or damage the thyroid cell to create an antibody, just like what you want to create for a virus. You want to create an antibody and go in and attack that virus.

Unfortunately, our body codes the message to the immune system to go in and attack the thyroid tissue itself. With thyroid peroxidase, there's a particular enzymatic and immune response. When it binds with the thyroid gland, it creates early apoptosis. Think about bubbling or almost like histamine or a mast cell response on that. That's where a lot of people with Hashimoto’s will clear their throat a lot and feel they have a hard time swallowing.

You'll go in and they'll say, “The thyroid is of normal size or palpates normally.” Sometimes in an ultrasound, you can see especially when the peroxidases are high. I've seen it and they almost look foamy. The tissue looks like it has almost water around it. It's an interesting ultrasound to see. When we look at what foods to incorporate, if you've had that diagnosis, there are a couple of things that I would recommend. Go to Food Rx and go to the chapter under autoimmune disorders. In that chapter with autoimmune disorders, there are specific labs that we run in our group of physicians and people that I work with that will help look at your markers.

Sometimes we have to get the chemistry stabilized. I get a lot of people with Hashimoto’s that have a difficult time with weight loss. Sometimes we have to get the chemistry stabilized before we can achieve weight loss. Sometimes we can put enough crutches in so we can achieve some weight loss while we're stabilizing the chemistry. A good friend of mine always says, “Try to perform while you transform. Try to get the scale to move while we're trying to get the chemistry stabilized.” What I always have my clients do, and you can go to the membership section, we have what's called a Protocol for Progress and it has an area where you can chart your labs.

PYP 19 | Thyroid Medication

 

A lot of you are probably on the computer now and you can look up your labs. Maybe there are some comparisons. I like to have a little notebook. I'm still a paper person when I work with clients and we're going into a doctor's office. That Protocol for Progress talks about the medications that you're potentially on, as well as labs that you want to look at consistently. With Hashimoto’s Thyroiditis, we look at things like anti-thyroid antibodies, thyroid peroxidase. We do look at TSH. We look at ANA, sedimentation rates, CRP, and things that show inflammation in the body. I also like to look at CK values. Those can be good to look at for tissue degeneration around the thyroid. It's a good idea to look at, chart and measure those.

Usually, with Hashimoto’s Thyroiditis, we have a four-month peak. Every four months, we'll look at those labs and make sure we're going in the right direction. The pain and inflammation protocol and the autoimmune protocol have great power foods and food list that are great to look at from a Hashimoto’s perspective. In my practice, we use a lot of the free radicals and a lot of them metabolism energy because of the quercetin, the bioflavonoids that are in there. The free radicals help with that advanced aging of the tissue itself and can be beneficial. It has a great anti-inflammatory aspect of it.

We have a great little thyroid breakout but remember, with Hashimoto’s, you're not thinking that you have a thyroid issue, you're thinking that you have an autoimmune issue that targets the thyroid. For example, dermatomyositis is an autoimmune disorder that will attack the lung tissue or lupus is an autoimmune disorder that has a high affinity for the kidneys. It's not necessarily that lupus is a disorder of the kidneys but it has that high affinity. If we can clear that up a little bit, it helps. It's good to see not only an endocrinologist but a rheumatologist that's well versed in this to help you manage and maintain your labs. If they aren't managing and maintaining your labs, watch the podcast that we did with Dr. Jackie Fields. You need to find somebody that's going to support you in this process because with any autoimmune disorder, there are a lot of nuances that happen in your body that require a lot of balance.

How To Back Off Of Medications

This is an interesting question. The next question is, “How do I normalize and back off of medications? I understand that you did this, Haylie.” Go back to your Protocol for Progress. Let me tell you one story first. I had worked with a client that was asthmatic and was on a lot of medications. In combination with their physician, I put together a protocol for what I thought we should do. I said, “This is what I'm thinking we're doing, can you help us fill out this medication form?” In that Protocol for Progress, it says, “I am on Zyrtec. I am taking it. I've been on it for however long you’ve been on it, and what would it take to be able to get off of it?”

That's what I always ask my physicians., “What would it take to be able to get off of it?” They might say, “It's used like a prosthetic would be used. You've had a thyroid resection or the thyroid is gone.” They might say, “Because we surgerized this tissue or it's no longer functional, we need to replace or add a prosthetic or a support in place to help the body function efficiently.” That's a great thing to put in your Protocol for Progress so you understand why. I had a client that was on a steroidal inhaler, a non-steroidal inhaler, a couple of different medications, did some steroid bursts sometimes with prednisone where you taper up and you taper down. We worked long and hard and she was able to successfully create homeostasis in her body where her body was no longer in need of those. We worked with her physician.

What’s funny is a girlfriend of hers came in and she walked in. She had a stack of meds and she says, “I'm done with these. I'm done. I'm not doing them anymore. I want you to give me exactly what you gave Kathy because I'm not taking these anymore. They make me hurt. They make me in pain and they give me a rash. I'm moody. I don't like them and I don’t want to take them.” I said, “Hold on a minute. Oxygen is important. It's important that your lungs are stable and you're not having asthma attacks.” If you're on a medication, the goal in my world is not to dump it and hope your body survives the process. Even if the medication isn't serving you, the act of taking any pharmacological medication will create adaptation. That's why they work when they're supposed to work. Going off of them, your body has to come back and create new homeostasis. You've got to be careful about it.

I went off of a ton of medication. I was on so much. I was on 60 milligrams of prednisone and I was able to get off of all of that, but it isn’t just one day. I had to be hospitalized to get off of prednisone because I had a lot of damage to my kidney. In my opinion, you don't one day say, "I'm done. I'm not even taking it." Even when individuals are taking things like Lipitor and they're on over 20 milligrams. When we work with doctors to get people off of those kinds of medications will taper down. We'll go from 20, 15, 10, 5 which I've heard from a doctor several times when I asked them to go to 5 before we dropped to 0. They say, "Haylie, that's like peeing in the ocean." I said that's, "That's okay. It makes us all feel better. It makes the body not so in shock when it has to create new homeostasis."

The first thing that I recommend, if you're not happy with the medication that you're taking and they're not performing the way that you want them to perform, because it's the whole purpose of taking them, is to be clear with what you're taking, why you're taking it, and what it would take to get off of it. If you don't have the opportunity to jump on a call with your doctor or email him or something, I call the pharmacy all the time. I'm a big CVS and Walgreens stalker. If I don't get a pharmacist that's not super friendly, I call a different store. If I can get the pharmacist on the phone because sometimes I have clients that come in and one client came in and they were on thirteen medications. Before we created our Dear Dr. Sanders letter, which is our Request for Care Letter, I wanted my client to have a clear understanding of what they were taking and what it's typically used for so we can understand the mechanisms in the body as well as if there were any drug interactions. In most of the chain drug stores, there are a couple of websites that you can do it. You can list all of the medications that you're on and it will let you know if there's potential for a mild, moderate or severe drug interaction.

Unfortunately, in my 25-plus years of practice, I cannot tell you how many times we've charted that in our Protocol for Progress, and there are severe drug interactions. Maybe they saw a cardiologist once, a GP once and a gastroenterologist once and everybody wasn't cohesive with looking at the drug profile, as well as if you refill all your pharmaceuticals at the same pharmacy, they're supposed to put it in a database and it's supposed to let you know, but you can't always trust that. You have to be your advocate. One time my father-in-law came into my office not feeling great. I said, “Bring all your stuff. Bring your supplements and meds.” He was taking two of the same meds. One in a generic name and one in the brand name. He was taking two of the same blood pressure medications so he was doubling his dose.

I have a bunch of websites that I use for drug interaction. There are even some good drug herb interaction websites that I use all the time. That's one of the first things that I do when I'm brought in on a case. I will assess everything first. No judgment, just assess everything. With this individual that I said came in with thirteen medications, we found some drug interactions. We had the conversation with their physician but the other thing that we found was there was stuff for constipation, nausea, heartburn, and things that had gotten piled on over the years. They had great insurance and great drug coverage so they were allowed to get refill after refill.

We said, “We want to work on the diet.” We want to pull things that aren't medically necessary or don’t feel medically necessary for the client or the patient. Which of these are the most benign that we can get out of here? That’s usually the route that we go when an individual is looking to reevaluate maybe their drug protocol. I always recommend and I love it if you can have a great internal medicine doctor as your primary care physician. If you can always make sure that your primary care physician has a good handle on everything that's going on with you. In that world, they look at the body much more holistically than maybe a cardiologist, a nephrologist or an orthopedic surgeon.

PYP 19 | Thyroid Medication

 

That was the other thing with this client that came in with thirteen different meds. She was on some crazy things from a shoulder surgery that it’s just gotten refilled. We started going through them and I said, “How long have you been on this?” She’s like, “I'm not sure.” “What are you taking it for?” “I'm not sure.” First, I define them. I make sure there's no interaction and I start to rank them. Even out of thirteen as we started to alleviate 1, 2 and 3, it took such a significant burden off of the body. Pharmaceuticals are meant to do something in the body. They're meant to be effective and helpful, but they come with a long list of side effects. They all come with the knowledge that it's going to take your body effort to process them and allow them to either be effective or hopefully, not create detriment. I hope that helps. If you're looking for something a little bit more specifically, let me know for sure.

Borderline Thyroid Numbers

We have a great one that says, “I'm borderline with my thyroid numbers, what can I do so I'm not put on medication?” This is an individual that wants to prevent medication. If the thyroid numbers are borderline, remember, the thyroid is not standalone. Even though we surgerized it, take it out and think that the body's hunky-dory without it, it works closely with the hormones of the pituitary, the adrenal hormones, with the estrogens, progesterone and testosterone. The glucocorticoids which I always tell regulate inflammation, blood sugar, allergy response, mineralocorticoids, which regulate the bone density, structure, muscle tonicity, collagen, elastin, pH, and your other hormone-ish, your ability to have stable vitamin D serum levels.

If I'm starting to see a client that's teeter-tottering, and I'm not sure when you're seeing which labs, but maybe the TSH is starting to get a little bit elevated. TSH is Thyroid Stimulating Hormone. FSH is Follicle Stimulating Hormone. TSH stimulates the thyroid to squeeze out its hormones and allow them to go into the bloodstream. It goes into the bloodstream. The liver helps make it bioavailable because it's not bioavailable in its first form. We're not bioavailable. We have few receptor sites for T4. All of that happens from a hormone from the pituitary. TSH is not a thyroid hormone. They're not measuring thyroid hormones. They're deducing how hard your brain has to talk to the thyroid to see if it's effective. That’s why people get confused a lot.

They say, “High TSH. My thyroid is high.” No, it means the brain has to yell at the thyroid to get up and get the dishes done. If the TSH is low, there's this nice intimate conversation that the brain has with the thyroid to get the dishes done. It’s the best way I can explain it to you. When you're telling me which labs, I'm not sure, but what I would say is go to the hormone in the Food Rx and make sure that they're looking at your endocrine system a little more holistically. If I'm starting to see thyroid hormones getting a little off or you’re TSH get high or you're pooling T4 and your T3 is a little bit low, remember the body takes T4. Those four iodine molecules. It cleaves one of the iodine molecules, which makes it T3. That is what can bind to the receptor sites and helps you burn fat and a lot of other things, brain, hair and skin. It's a superhero.

If you're pooling T4 and you're not converting to T3, those are the things to look at. I would look at your fractionated estrogen, progesterone and testosterone. Ideally, on day-three cycle, if you're still having your period, if you’re not and you can go back in the dark ages like me, and remember when you were having your period and go, “What is my cycle?” If you feel your cycle earlier in your cycle, the better. The thing is when you're looking at norms and those endocrine panels, you want to make sure that you're looking at where it would be in a cycle because you'll see those numbers. When you're postmenopausal then say, “You are not supposed to have any hormones. You should have some hormones.”

Look at the whole endocrine panel and make sure that you're taking an ample amount of good vitamin D. Have a look at ACTH, the adrenocorticotropic hormones. That's a good one when your body is starting to elevate the TSH and the pituitary is having to start to scream at the thyroid to get up and do the dishes. You want to look at your adrenal reserve and I love that ACTH. That's a great one to look at. Do lots of things that are going to support the liver and think about things that are heavy metal related.

The thyroid as a tissue has the highest affinity for heavy metal toxins of any tissue in the body. That's why you want to wear a thyroid shield when you go get an X-ray. That's why we use iodine when they had the nuclear spill in Japan several years ago. Iodine is used to be a nurturing nutrient for the thyroid. The thyroid uptakes that quickly. If you're borderline looking at the heavy metal cleanse, be consistent on your ten-day cleanse. This is nurturing for the liver. Look at maybe doing a Phase 2 Super-Intensive and recheck those numbers and see what they are.

Make sure you're getting a whole holistic panel, and they're not running the thyroid once, and then they're running a month later the estrogen. Two months later, the testosterone and you’re a puzzle piecing together. You need to look at it. What I usually like to do is on day-three of the period or the beginning of the cycle, and I like to do that three months in a row consistently if we can before we make an opinion on something. Unfortunately, with one lab or sometimes with one take of the blood pressure cuff, were put on medication. As long as there's not some crisis intervention that's happening like a thyroid storm, get some data before you put something in that manipulates the body that way.

Thyroid medication on empty stomach. From what I understand, ask your doctor. I've got a lot of people that take thyroid medication at night before bed so they don't have to get up, have food and take their supplements and things like that. Mineral-based supplements, we are typically a little bit more cognizant of taking that with your thyroid. For example, I have some individuals who have blood sugar issues that are also on thyroid medications. One of the things that we'll do is Phase 1 powder because it doesn't have the minerals in it but it's got some protein. We'll do a scoop of the Phase 1 powder, keep their blood sugar stable if they're diabetic, if they’re prone to inflammation, and use that with their thyroid so they can have a protein source, but not a heavy mineral-based one. It's also got all the nice pieces in it to help the adrenals which can create a lot of stability with the thyroid.

There's some debate whether you're on Synthroid, which is a synthetic or Levothyroxine, which is a synthetic thyroid, or if you're on one of the glandular, Westhroid, Nature-Thyroid, Armour or natural compounded. I usually tell people to try to have it away from mineral-based food which hopefully, you're eating whole foods. Those are super rich in minerals. I usually say to talk to your doctor and see if they're cool with you taking it at night. I have a lot of people that do that and it doesn't have a tendency to create a disruption in sleep.

If you're asking me if you have a compound fracture and you should go get the bone repaired, I'll probably say, “100% of the time.” If you're asking me a question about the endocrine system, I always go, “That's interesting. What data can we get from your body?” Please make sure when you're doing anything that modifies your endocrine system, whether It's hormone replacement therapy, that you're looking at that. I'm going to add one little thing to that. I'm a big natural compounded pharmacy girl. Nature-Thyroid used to be the only one that's gluten-free and Armour wasn't. There was some shortage and Westhroid was off the market for a while. You’ve got to play with it a little bit more or put a little more effort into your health with the naturally compounded.

 

I had a doctor one time that I worked with a lot that said, “Haylie, I don't like the naturally compounded because it's harder for me to regulate the number." I go, "Yes, because the body can get rid of what it doesn't need and use what it needs." The one exception to that, and this is something that I've seen over the years, if we have an individual that has Hashimoto's, a lot of times they don't do well on the glandular. They do typically a little bit better on the synthetic. They do a lot better on the T3 and not the T4, so more of the Cytomel. You have to have a pretty savvy doctor to give T3 because that's the superhero of the superhero. The body can’t break it down as efficiently if you get too much of it. I always say, if you have a doctor that's concerned or doesn't feel confident about T3, maybe ask to bring somebody else in that has a lot of experience. On the flip side, if you have a doctor that gives T3 like it's candy, be a little concerned. We do a lot of basal body temperature measurements when individuals are using T3. I love it. I am a huge advocate of not just using T4.

Just to clarify, if you're on Synthroid using Cytomel as well, some people with Hashimoto’s use just a compound and T3 or just Cytomel. Remember the endocrine system? It's interesting. What is your body telling us? Always have that hat on clear, concise and clean data. Before you go into the doctor's office. Fill out your Protocol for Progress and your Request for Care. Make sure that there's data over time with the endocrine system. Men and women have cycles. For women, sometimes we have our periods 28 days or  21 days. We all accept and understand that there's an adaptation in our bodies when we're having menses. Yet, for some reason, we don't expect an adaptation and that same gentleness with our bodies when we're talking about the thyroid. Be cognizant of that.

Low Carb Day Problems With Hypothyroidism

The last one, “I am hypothyroid. I'm on medication and my labs are in the good range according to the book. I have a horrible time on the low carb days like Phase 2. I can't sleep and I’m cranky. Any advice?” The pituitary is the orchestra leader. The thyroid is the regulator. When our body is cleaving our hormones, when we have our adaptive hormones, and I'm going to talk about one class which they're called Glucocorticoids. I always tell you that those regulate blood sugar, allergies, inflammation, and a lot of the prostaglandins so a lot of the sex hormone stuff.

When we're on thyroid medication, and it's created a stabilization in our bloodstream, our regulator gets a little bit rigid. The adaptability in our body to efficiently regulate blood sugars can be off when that prosthetic or that support is in place. I do find those individuals that when they go on something low-carb that their body gets typically a little bit of elevation in testosterone. When we had in-house labs, we would check labs like crazy. It’s like, “Take some blood. I want to know what’s going on.” We get a little elevation in testosterone, we get our prostaglandins, our pro-agitation hormones, which we want to be agitated when we need to be agitated. That's how we know we are about to step on sharp glass. As that agitation happens, we pull away. It’s a very important hormone to have, but they aren't as pliable. Our adaptogenic hormones aren't as pliable sometimes when we have a thyroid medication in place.

I find that more over the years with individuals that are on the Synthroid and Cytomel version or if they're just on a Synthroid alone. If Synthroid alone, the Levothyroxine can create a stabilized TSH even your reverse T3 sometimes. With a free and total uptake of T4, T3 and even T7, we can find those stabilize nicely. Sometimes if they quit a little bit of T3 in there, your adaptogenic hormones are a little bit more nurtured and/or you can use adaptogenic herbs like ashwagandha, which is an ayurvedic which is supportive from an adaptogenic perspective. Guggulsterones, which are also supportive. To give you a little bit of that roll with the punches and go with the flow, no worries, I'm not worried that you're late, I'm not worried the meal is not prepped. Guggulsterone is good for that. The rosemary, which is good for the receptor sides of the hormones.

You want to check with your doctor. I find a lot of people that are on Synthroid that aren't reaping the benefit of the weight-loss enhancement. They usually need more adaptogenic support, which is probably why you like the complex carbs. We will do a lot of Phase 1 Super-Intensives, and a lot of T4 and T3 support with them, and see, with the fact that the regulator is nice and stable, if we can get the body now with that stability to be able to dance around the fluctuations in blood sugar and stress hormones.

When you do Phase 2 even for those two days, you’ll probably find that you feel edgy and agitated. I even find that when the adaptogenic hormones haven't been balanced, nurtured and feed enough, oftentimes those individuals will feel sensitivity to light and sound. It’s the nails on the chalkboard type of feelings. Some suggestions. Sometimes I have those clients that will do Phase 1 for three days, Phase 2 for two days, and Phase 3 for two days. Sometimes I will do a little bit of a rotation where I'll go Phase 2 for one day, Phase 1 for one day, Phase 2 for one day, then three days of Phase 3. We're doing a little bit more of a push-pull. Instead of two days of Phase 1, two days of Phase 2. We’ll go, 1, 2, 1, 2, and then into 3. You have such amazing questions. I love chilling with you, giving you my perspective and things that I've experienced from my journey in this life. If you have more questions, please ask them. If I didn't get to your questions, please repost them and we will put them back in. I don't want to take too much of your time. Have an amazing day.

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