Hypothyroid, Hashimoto's, and Labs

I frequently see patients  who have been diagnosed with hypothyroidism who do not know the answer to one of my first questions: is the cause Hashimoto’s Disease?  More often than not, the answer is, “I’m not sure, my doctor said that didn’t really matter because the treatment is all the same.” Respectfully, I could not disagree more.

Hashimoto’s is the number one cause of hypothyroidism in the United States, and it is an autoimmune disease.  With Hashimoto’s, the immune system inflames and attacks the thyroid gland.  White blood cells accumulate in the thyroid and cause it to enlarge, but thyroid hormone production is reduced because the thyroid is systematically damaged. Symptoms often gradually and insidiously develop to include:

  • Fatigue

  • Weight gain

  • Feeling cold

  • Constipation or sluggish digestion

  • Hair thinning or dry hair

  • Difficulty becoming pregnant, or miscarriage

  • Irregular or heavy periods

  • Depression

  • Foggy feeling or forgetfulness

  • Muscle aches or pain

  • Headaches

Traditional teaching is that all hypothyroidism is created equally, and all is treated with levothyroxine (Synthroid).  Levothyroxine is the nation's most prescribed medicine, it is the very definition of a one size fits all approach. In my experience, levothyroxine is a wonderful and often life saving medication for many people, but not everyone responds equally.  

Levothyroxine works by supplying T4 thyroid hormone, which is converted throughout the body into the more usable T3.  That process works well for people whose hypothyroidism is not caused by an autoimmune inflammatory process.  In Hashimoto’s however, one of the antibodies made by the white blood cells (TPO Antibodies) attacks the enzyme that helps convert T4 to T3, rendering artificial supplementation with T4 inadequate. Unless, that is, you manage to dramatically reduce your TPO antibody level, allowing T4 to effectively resume conversion to T3.  

You are probably wondering at this point where you start and what you do to investigate and treat your thyroid condition properly.  I want to make this as clear and applicable as possible so here is a step-wise breakdown of what I recommend.

1) If you have symptoms of hypothyroidism, begin by asking your family if anyone has been diagnosed at any point with a thyroid condition.  Go as in depth as you can and ask about aunts, uncles, and grandparents, as well as your nuclear family.  Hashimoto’s hypothyroidism runs in families.  In my experience, if one person has it, someone else does (or will) as well.    

2) Get as full of a thyroid panel as your budget reasonably allows.  Lab tests can be pricey, and insurance often does not cover the full testing functional medicine practitioners recommend.  My definition of essential preliminary testing for investigating a thyroid issue is:  TSH, free T3, free T4, TPO antibodies, and Thyroglobulin antibodies.  If money's no object, add in a reverse T3.  If you’ve already had an abnormal thyroid test, I would also recommend assessing vitamin and micronutrient levels, which are critical to optimal thyroid health.  Specifically, vitamin D, ferritin (iron), selenium, zinc, and magnesium (RBC levels).  Some labs such as Genova Diagnostics and Spectracell have test bundles, allowing for more extensive testing at a deeply discounted price.  

3) Understand that what is considered “normal” on most lab reports truly just means adequate for survival, not necessarily what makes you feel well. The ranges that I consider optimal for my patients are much tighter than those used in the traditional approach to managing hypothyroidism.  This is one area where Allopathic (M.D.) medicine and Functional Medicine differ greatly. This is also why many of my patients have come to me, they are tired of being told that they are “fine” when they feel less than.  I can’t begin to count the number of Hashimoto’s patients who have come to me after being told that their symptoms are not due to their thyroid and that they should instead consider seeing a Psychiatrist.  

4) If you have been found to have Hashimoto’s hypothyroidism, or elevated thyroid antibodies in the setting of normal thyroid function, don’t try to go it alone.  Find a physician who is able spend adequate time getting to know you and your health.  Functional and Integrative Medicine doctors enjoy the investigation and thrive on putting all of the pieces together.  Willingness to use alternatives to levothyroxine, such as whole thyroid replacement, compounded T3 and T4, nutritional therapy, micronutrient repletion, herbs, and adaptogens, may be challenging to find, but it will be worth your time and energy to do so.  Don’t be afraid to ask potential practitioners how they most often treat Hashimoto’s so you have a sense of whether or not they are open minded and a good fit.  I love my physician colleagues, but when referring my patients, friends, and family to them, I am sure to seek out the ones who are willing to at least consider life beyond what we all learned in medical school.  

If you are diagnosed with an autoimmune condition, you are at risk for development of additional autoimmune diseases such as MS, Rheumatoid Arthritis, Lupus, or Psoriasis.  Getting a handle on gut health, toxin exposure, vitamin and micronutrient levels, and inflammation is the path to healing.  I liken the thyroid to the canary in the coal mine, you have warning and you can change your destiny.  Unless you want to steadily increase your levothyroxine dose for the rest of your life while continuing to feel unwell, break free of the one size fits all approach to hypothyroidism.  It’s not in your head, this doctor believes you.

Allison Fox, M.D.

If You've Ever had an Abnormal Pap, This Article is for You

HPV (The Human Papillomavirus) is the single most common STD in the U.S., affecting upwards of 79 million Americans. It is so common that approximately 14 million people become infected every single year.  Based on my own experiences when counseling my patients about their HPV diagnosis, most people do not realize how much they can do themselves to help their body eliminate it.

HPV is screened for on routine Pap smears, which is of course only a fraction of the reason why seeing your healthcare provider routinely is so critically important.  The HPV virus causes genital warts, abnormal Pap smears, and ultimately, if left untreated, cervical cancer.  HPV is also responsible for several other less common, but unfortunately on the rise, cancers.

When HPV is found on a Pap smear, the conversation usually goes something like this: "You have an STD called HPV. Sometimes your body gets rid of it on its own, and sometimes it doesn't. We would like to get a better look at your cervix to see if the virus has caused damage. Be sure to schedule that test, which is called a colposcopy, before you leave. The procedure is quick, but it is not painless. You’ll want to take ibuprofen ahead of time to help with the discomfort. If left ignored and untreated, it could cause cervical cancer." Yikes! Is it any wonder that most people leave these appointments confused and mortified!?

Here is the part of the story that rarely makes it to prime time.  With so many other important topics to go over on you routine doctors visit, there is often not enough time for this. There are in fact things you can do to help clear the infection up.  I’ve outlined them below for you.

1) Eat your folate! Folate is a B vitamin found in dark green leafy vegetables, and it has been proven to  help rid the body of HPV.  It is always preferable to obtain your vitamins through food, but there are supplement options as well. Dosage and formulations vary, and make a huge difference, so I don't recommend navigating this one on your own.  It’s important to know that some people have a gene that actually makes synthetic folate (folic acid) dangerous. There is, however, no risk to experimenting with that new kale, swiss chard, broccoli, or spinach recipe you've been wondering about - your body will thank you!

2) Quitting cigarette smoking is also proven to help clear up the HPV virus.  If you smoke, your body is constantly fighting an uphill battle to stay healthy. The HPV virus loves smokers! My patients that smoke seem to be perpetually HPV positive despite their best efforts to heal the infection.  

3) Stress and poor sleep make recovery from HPV more difficult.  High emotional stress levels are associated with increased oxidative stress.  Oxidative stress is linked to an increase rate of progression of HPV to cancer.  If you needed one more reason to learn to meditate and get a good night's rest, perhaps your abnormal Pap smear is it.  Learn more about fighting oxidative stress here

4) There is convincing evidence that other essential vitamins and nutrients also play a role in healing from HPV. Some of those other supplements include Vitamin B12, Vitamin C, Vitamin E, Retinol, Beta and Alpha-Carotene, Lycopene, Lutein/Zeaxanthin, and Cryptoxanthin.

5) Long term use of hormonal contraceptives (the pill, the ring, the patch, etc.) is linked to persistent and aggressive HPV infection.  There are safe effective contraceptive options that do not involve the use of systemic hormones.  Talking to your provider about them is never a bad idea, especially if you have HPV.

The most important piece of advice I can give you is to rethink your body's relationship with the HPV virus.  You are not a helpless victim of this virus, you are at war with it - and if you work with a knowledgeable physician to make a few adjustments in your diet and lifestyle, you can win.   

Allison Fox, M.D.