It’s true, thyroid, primarily hypothyroidism, is under-assessed, under-addressed, and leaves a lot of people feeling like crap, at risk for numerous states of disease- all the while they have been told their thyroid is fine.
We understand the issues of the lack, or under testing- as it seems par for the course is free T4 and TSH, which is not a plausible assessment when a patient has low thyroid symptoms.
Have you have had a patient who had their thyroid radiated, to the point it was not working? What was the thyroid dose they were prescribed?
If someone has no thyroid activity at all, the replacement dose of T4/T3, is 100 mcg and 30 mcg respectively, due to equivalent of healthy natural daily thyroid production.
So, does it make you wonder, why you have patients that still have thyroid activity, but are on dosages exceeding this?
The reasons can be many, from nutritional depletions, elevated antibodies, lack of conversion, heavy metals, food intolerances, adrenal dysfunction, inflammation, etc, etc, etc.
And often the job is to put the detective hat on, and with the tests you have access to and the symptoms they present, find what is leading to the need for hyper physiologic doses.
I think you can create a business all by itself of making someone’s thyroid work more efficiently.
So let’s look at two of the many reasons for such thyroid insufficiency that you might not often think of.
First one is Gut Health.
Whether we are talking about dysbiosis and imbalance of gut flora, or inflammation, food intolerances, or full blown auto-immune activity- there is a critical thyroid-gut connection.
When the gut is out of whack:
· One can experience less absorption of thyroid medication
· Increase antibody’s rendering the active thyroid useless
· Impaired conversion of T4 to T3
· Increased reverse T3
· Increased thyroid binding globulin
· Low T4 and low T3 levels
· Dull thyroid hormone receptor sites
· Decrease TSH
Excipient Ingredients in Thyroid Medication
Leaving off from the inflammation, a common practice of compounding pharmacies, which can provide a great benefit is to customize a thyroid preparation in a sustained release capsule. This is often done by adding methocel to the preparation, although in the presence of gut inflammation, can lead to a dramatic reduction in thyroid medication absorption.
Then there’s lactose. Many commercial thyroid products might use lactose as an ‘inactive’ ingredient, which might be just as well be referred to as a ‘deactive’ ingredient, as lactose has been shown to interfere with absorption of thyroid up to 40%, thus affecting absorption.
These are just two of the many reasons to look for in assessing and dialing in someones thyroid.
More on this can be found in our Report, Thyroid Roadblocks Standing in The Way To Feeling Great, available in the report section of our Functional Pharmacy INSIDER.
Jim Paoletti’s A Practitioners Guide To Physiological Bioidentical Hormone Balance
Pam Smiths: HRT The Answers
Chris Kresser blog post: The Thyroid-Gut Connection