Thyroid: A Work in Progress
“Optimal thyroid function is crucial for optimal cognition, and suboptimal thyroid function [hypothyroidism] is common in Alzheimer’s disease,”
Dr. Dale Bredesen, “The End of Alzheimer’s.”
I’d wondered more than once before reading Dr. Bredesen’s book if my thyroid was working suboptimally because I frequently struggled with fatigue, having very little energy. Quick Google searches for hypothyroidism, however, had all shown the same primary symptoms: weight gain and hair loss. Since I had lost substantial weight over the previous few years and my hair only grew thicker as a result, I thought my thyroid likely wasn’t the culprit. I then had my thyroid stimulating hormone (TSH) tested in early 2017 with a result of 2.1 IU/l — well within the “normal” range provided by my doctor.
The job of thyroid stimulating hormone is exactly what its name implies: It’s released by the pituitary gland when the thyrotropin-releasing hormone sends a signal that the thyroid is not producing enough of its own hormone. TSH sends a boost, stimulating the thyroid into proper production, so a high TSH indicates a low-functioning thyroid. “Normal” TSH levels range from 0.4-4.2 IU/l, but Bredesen says any level above 2 is “concerning.” He also says people should request a full thyroid panel of free T3, free T4 and reverse T3, along with TSH. Doctors typically will only test TSH, but that doesn’t paint a complete picture of thyroid function and people can have low-functioning thyroid and still have normal TSH levels.
Free T3, he says, is the “active but short-lived thyroid hormone” with optimal levels of 3.2-4.2 pg/ml, and free T4 is a “storage hormone” with optimal levels of 1.3-1.8 pg/ml. Reverse T3 “inhibits thyroid activation.” Its optimal level is less than 20 ng/dL
“That is why one of the most important measurements of thyroid function is the ratio of free T3 to reverse T3,” he writes. “Levels of reverse T3 increase with stress and reduce the effectiveness of T3.”
The ratio of free T3:reverse T3 should be at least 20, he says.
“Since thyroid function affects metabolic speed, it affects your heart rate and your mental sharpness,” Bredesen writes. “It can also have an impact on how long you sleep, whether you feel cold or hot, whether you gain weight easily, whether you become depressed, and many other health parameters. Furthermore, most people with dementia, mild cognitive impairment, and subjective cognitive impairment have suboptimal thyroid function. Therefore, it is essential to know your thyroid hormone status.”
Bredesen also suggests a simple at-home test to determine if the thyroid could be working suboptimally: Take a standard thermometer (not digital), shake it down and place it by your bed before going to sleep at night. Then first thing the next morning, before getting out of bed, place the thermometer in your armpit for 10 minutes to learn your basal body temperature. (This is not easy when you wake up with a full bladder!) The temperature should read between 97.8 and 98.2 degrees. Anything below that likely indicates hypothyroidism. Wanting an accurate reading, I decided to test my temperature several days in a row. My results were 97.4, 97.7, 97.6 and 97.7. So close to that 97.8 threshold but not quite! This and my slightly high TSH made me wonder again, but it didn’t seem to be anything so terrible that it couldn’t wait until my spring 2018 OB-GYN appointment. I decided I would insist on a full-panel test then.
Then in the first quarter of 2018 I began experiencing hot flashes and night sweats. I had forgotten by this time what Bredesen says about the thyroid affecting how hot or cold someone feels. I instead thought, how could I be having hot flashes already when I’m only 40 years old? Another question for my OB-GYN. That winter was interesting. I was hot ALL the time. I wore T-shirts almost every day and usually skipped the coat. My sweaters and sweatshirts remained on the shelves of my armoire, collecting dust. I would be at my desk at work when all of a sudden my face and ears would flush and burn, and I would get so hot that I had to run outside to the freezing temperatures to help cool off. The thick cozy blanket on my bed, which I usually love in the winter months, was fully removed after several nights of kicking it off when I woke up drenched in sweat. My usual warm winter pajamas also had to go. I couldn’t sleep if I had more than a sheet covering me and didn’t have the ceiling fan going — and this was with a typical winter bedroom temperature of about 63 degrees.
My OB-GYN appointment arrived in February 2018, and my doctor agreed I should look into hormone testing, including the full-panel thyroid tests, reminding me that hypothyroidism can also cause hot flashes. My TSH was 3.1, free T3 was 2.5 and free T4 was 1.18. All three were still in the “normal” range but not within Bredesen’s optimal. For some reason, my reverse T3 was not included, so I can’t figure the ratio that Bredesen says is so important — mental note: next year I will insist upon it!
My doctor said while considered normal, the fact that my TSH jumped from 2.1 to 3.1 in a year was concerning and warranted action. I asked if I could try a more natural route first, such as beginning an iodine supplement. Iodine is a critical component in thyroid function and low iodine is often the culprit for hypothyroidism. She said I shouldn’t because the sudden TSH increase needed stronger, immediate attention. She prescribed Armour Thyroid medication and then said thyroid issues aren’t really in the realm of an OB-GYN and passed me over to my family doctor.
All hot flashes ceased immediately after starting the medication. I went from being hot all the time to being cold all the time. The appointment with my family doctor arrived in July 2018 and I was tested again, but now the free T3 was not included for some reason. My free T4 bumped up to a healthy 1.4, and my TSH dropped to 1.9. I was very happy and continued with the Armour Thyroid for the next year. I always wondered, however, if my issue couldn’t be helped if not fixed by taking iodine. OB-GYN Christiane Northrup writes in her book, “The Wisdom of Menopause,” that taking an iodine supplement often improves and may even cure hypothyroidism.
“When iodine levels are ideal (which can be reached by taking between 3-12.5 mg of iodine per day, either in drops, in tablets, or by eating iodine-rich seaweed), metabolism and thyroid function often normalize on their own,” she writes.
The standard daily recommended dosage of iodine is 150 micrograms, which is equivalent to 0.15 milligram. So taking Northrup’s recommended 3-12 milligrams seems astronomical to me. This past spring I decided to purchase an iodine liquid supplement in which 1 drop equals 150 micrograms and is the recommended daily serving listed on the bottle. Taking 20 drops a day just to reach the 3 milligrams just didn’t seem right, especially since Northrup also cautions that taking too much iodine can shut down the production of thyroid hormone. She also says to introduce it very slowly. I decided to take just one drop a day on an empty stomach with a glass of water, as recommended, to see how I felt. I noticed no changes, so I bumped it up to two drops after a few weeks — still no changes.
My next annual visit with my family doctor arrived this past July, and she ordered the thyroid panel again. I asked her about an iodine test and she actually seemed flustered and stammered that she’d never heard of such a test and wouldn’t know how to order one. OK. I thought that rather odd. So I guess I will have to wing it with the iodine supplementation. I also asked about the possibility of going off my thyroid medication. I said my numbers weren’t that far off the optimal range and were still within normal, and I wondered if my thyroid would be able to stand on its own two feet with the help of the iodine. She agreed to the trial, saying I wouldn’t need to wean myself off slowly, that I could just stop taking it.
I’ve said in my previous posts on hormones that I was fed up with trying to control them and wanted to give my body a chance to heal on its own and get back to a normal rhythm and flow. I feel this way about my thyroid as well. I stopped taking the Armour Thyroid the day of my appointment and upped my iodine to three drops. Five days later I went in for my blood tests. My TSH had skyrocketed to 4.87 and my free T4 dropped back down to 1.19. Sigh. I found it hard to believe my TSH would jump that much in just a few days of being off the medication, though perhaps it’s possible. I wondered if the high number was more due to my newly discovered hemochromatosis and the previous year’s iron supplement overdose. After all, hemochromatosis (iron overload) damages the pituitary, which in turn depresses thyroid function, causing hypothyroidism.
Still, my doctor made no comment on my high TSH, and I still wanted to give my body a chance to heal on its own without the crutch of an outside medication, especially now that I understand hemochromatosis and how to manage it. So began my next health experiment. Despite the high number, my symptoms have only improved since stopping both the progesterone and thyroid hormones. I’m definitely going through an adjustment as I’m still getting an ebb and flow of mood swings, water retention, ankle swelling and weight fluctuations, but it takes a good 3-6 months for the introduced hormones to fully leave my system and for my body to adjust. So I wait, sometimes patiently, sometimes not so much, but I wait. I’m not at all against restarting my Armour Thyroid medication if my next blood test continues to show hypothyroidism, but so far, the hot flashes have not returned and I feel better than I have in months.
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