Thyroid Tune-Up

I am re-posting a classic Wheat Belly Blog post from a few years ago. Despite all our discussions about thyroid issues, there continues to be an enormous information gap: undiagnosed hypothyroidism, gross mismanagement sufficient to impair weight loss and increase cardiovascular risk, dismissing the importance of iodine, and ignorance among healthcare providers. This Thyroid Tune-up is therefore an updated version of the previous post.

Imagine that all the cars in your neighborhood run poorly because nobody bothers to tune-up their autos. I show you how to tune the cars and, lo and behold, 80% of the cars now run great. But 20% of cars still run poorly because their transmissions are bad. In other words, tuning the engine works when that’s the only problem with the car; if something else is wrong, then your car will not run properly.

So it goes with eliminating wheat and grains from the diet. It works right out of the box for the majority of people: substantial weight loss and shrinking waist size; reduced blood sugar and blood pressure; relief from arthritis, leg edema, acid reflux, irritable bowel syndrome symptoms, etc. But some people complain that, despite saying goodbye to all things wheat, they still have problems. Obviously, as big a problem as modern wheat and other grains are, there are other causes for health conditions. There are nutritional deficiencies, infections, injuries, sensitivities to other foods, inherited conditions, etc. While wheat and grain exposure are causes for an incredible amount of human suffering, it is not the only cause.

How about weight loss? If all things wheat and grains are eliminated, most people can expect substantial weight loss. We also need to reduce exposure to other carbohydrates, especially if a lot of body weight needs to be lost and/or pre-diabetic or diabetic patterns are present. I cannot say “eliminate wheat and eat all the ice cream and candy you want.”

Then there are people who do all that and still cannot lose weight. This is when it’s time to give serious consideration to thyroid dysfunction.

By “thyroid dysfunction” I am referring to various degrees of hypothyroidism, i.e., low thyroid hormone levels. (I’m going to ignore hyperthyroidism, since this is much less common and does not impose any limitation on weight loss.) This is a big issue, so I’m going to cover it as a check list, a series of bullet points that you can run down to cover as much territory as possible. There are three blood tests that everyone should have assessed to even start thinking about thyroid dysfunction: TSH (thyroid stimulating hormone), free T3, and free T4. Optionally, a reverse T3 and thyroid antibodies (to identify thyroid inflammation/autoimmunity) can also be helpful. You do not need all the other nonsense often run, such as total T3 and FTI; these are outdated and often misleading.

Important issues to consider in deciding whether hypothyroidism is contributing to stalled weight or other health problems:

Hypothyroid symptoms–Beyond stalled weight loss, the most common symptoms of low thyroid hormone status include cold hands and feet; low energy; mental “fog;” loss of hair and eyebrows; constipation; leg edema.

Low first a.m. oral temperature–An oral temperature immediately upon awakening can help you decide whether a thyroid question is present or not. Using a digital thermometer, take your oral temperature immediately upon arising.> If it is consistently below 97.3 degrees F, then hypothyroidism is likely; the lower the temperature, the more likely and severe the thyroid dysfunction. However, note that disruptions of cortisol can do the same, as can anemia and failure to take in prebiotic fibers. (Contrary to some older discussions from the 1960s, axillary temperature should not be used due to excessive temperature variation.)

Iodine deficiency–Though it’s not even on most people’s radar, iodine deficiency is a common and under-diagnosed cause for inadequate thyroid hormone production. The thyroid requires iodine to manufacture thyroid hormones, T3 and T4, the “3” and “4” referring to the number of iodine atoms per thyroid hormone molecule. Iodine deficiency was a huge public health issue up to the last half of the 20th century, pretty much solved by the introduction of iodized salt. Now that salt overexposure in some populations has been fingered as a potential health problem, the FDA and other “official” providers of health advice tell us to reduce salt and sodium. But what about the iodine? Everyone forgot about the iodine.

Many people, including physicians, assume that iodine intake from diet is sufficient. Nope. Even the federally-funded NHANES data have uncovered substantial deficiency in some demographic groups, such as women of childbearing age, using a relatively lax definition of iodine deficiency. I’m seeing iodine deficiency and even goiters (enlarged thyroid glands due to iodine deficiency) frequently. Beyond having a goiter, a low free T4 and highish TSH (e.g., 3.5 mIU) is suggestive of iodine deficiency.

Iodine is not optional; it is necessary for health, including breast health, oral/gastrointestinal health, and the health of a developing fetus. The RDA for non-lactating adults is 150 mcg per day, the quantity required to not have a goiter, but not necessarily ideal thyroid health. I’ve therefore been advising 300-500 mcg per day from an iodine supplement, such as kelp tablets (dried seaweed), available at health food stores. The only adverse effects of iodine arise in people who have autoimmune thyroid disease, such as Hashimoto’s thyroiditis, unsuspected thyroid nodules, or longstanding and severe iodine deficiency. In most cases, very low doses of iodine, e.g., 50-100 mcg per day, can be introduced and increased gradually over months after wheat/grain elimination and vitamin D has been restored (factors that allow autoimmune thyroid inflammation to recede). Ideally, this would be undertaken by your healthcare provider, but good luck finding one knowledgeable about iodine.

For most people, restoration of iodine usually develops over 2-3 months with gradual relief from hypothyroid symptoms (but only if iodine deficiency is the cause).

Ideal TSH–Notice I didn’t say “normal” or “reference range” TSH. I look for ideal TSH. Contrary to the values often cited as “normal” or “reference range” on laboratory values, ideal TSH is in the range of 2.0 mIU or less. This is the level at which thyroid dysfunction no longer contributes to stalled weight loss, as well as distortions of lipid (“cholesterol”) values and cardiovascular risk. The higher the TSH above 2.0, the greater the hypothyroidism.

Ideal free T3 and free T4–The upper half of the “reference range” quoted by your laboratory can serve as a reliable guide to desirable or ideal levels of these thyroid hormones. In particular, low free T3 levels are becoming a common problem and a frequent cause of stalled weight loss. It is not clear why T3 levels are impaired, but potential explanations include disturbed circadian variation of cortisol levels and exposure to organochemicals such as perchlorates (residues of synthetic fertilizer in your produce and water), triclosan in your antibacterial hand soap and hand sanitizer, and others. Unfortunately, the endocrinology community (which is woefully unhelpful with thyroid issues) sooner prescribe antidepressants than treat low T3 levels, which they regard as a non-issue.

Reverse T3–Less commonly, some people develop a T3 thyroid hormone mimic, reverse T3, or rT3, that blocks the activity of T3 in the body. In this situation, it is worth more seriously considering disrupted circadian cortisol variation and using higher doses of T3 thyroid hormone to overcome the blockade.

Should prescription thyroid hormone replacement be chosen, most people do best by including the T3 thyroid hormone, liothyronine, along with T4, levothyroxine. They can be taken separately or as a single tablet in desiccated thyroid gland preparations like Armour Thyroid or Naturethroid. If you already take a T4 preparation like Synthroid or levothyroxine but have stalled weight loss or persistent symptoms of hypothyroidism, then adding T3 nearly always solves the problem.

Unfortunately, the biggest hurdle in obtaining helpful feedback on your thyroid is usually your doctor, who will declare your thyroid status normal usually by just looking only at TSH and seeing whether it is in the “reference range” quoted by the laboratory–if he/she even bothers to check it at all. Lately, the functional medicine and naturopath communities have been very helpful to many people in my area eager to have their thyroid status intelligently assessed. As a last resort, you can purchase fingerstick test kits to obtain thyroid measures, such as the ZRT test kits you can purchase through Amazon and other online retailers.

Once properly corrected, the majority of people enjoy resumption of weight loss, not to mention feel happier, more energetic, with improved overall health, including reduced cardiovascular risk. Add that to the health and weight benefits of wheat/grain elimination, and you can make substantial strides in regaining ideal health.