Treating Patients With Hashimoto's Disease: Your Questions Answered

As a follow up to our webinar with Thyroid Pharmacist Izabella Wentz, PharmD, she addresses questions about thyroid function and Hashimoto's Disease. Here are your questions answered. 

I have a patient who has your book. She has multiple gut issues, and I've tried to get her to eliminate wheat, gluten and dairy for years. She refuses. She wants to take antabine or the naltrexone you recommend but not change her diet. I haven't read your book yet, but I told her she was missing the entire title, which is root cause. Please comment.

Oh no! The book is all about lifestyle and talks about the antabine & LDN being adjuncts. We both know she will likely feel much better once she gets off the gluten and dairy, unfortunately, often times people have very complicated relationships with food... some people live to eat, and it's going to be a real challenge to get them to see food in a different way. Of course we also know about casomorphins and gluteomorphins that make dairy and gluten so addictive.

I would work with her to discover why she is so resistant to change. If she is just collecting information and trying to prepare, you may be able to point her to some great resources. It took me over a year to go gluten and dairy free as most of my meals consisted of both gluten and dairy.

She may not be ready to change at this time, the fact that she is seeing you however, is a great step for her. Some things that may encourage her to change: let her know LDN and antabine work best with an anti-inflammatory diet, have her try the diet for just 3 weeks to see how she feels off the foods, and do lgG food sensitivity testing (that was the kicker for me).

Is a thermagram a good indicator of hypo or hyper thyroidism?

I don't have much experience with thermography, in my opinion, while the thermograms would be a helpful adjunct in diagnosing thyroid disease, inflammation, nodules and hyperactivity of the gland, I'm not sure that the information could be quantified for practical purposes such as dosing medications, etc.

Is it important or useful to do an iodine load, testing before and after the load?

I prefer the urine spot test for people with Hashimoto's instead of the iodine loading test. Iodine is a narrow therapeutic index nutrient and can exacerbate the autoimmune attack on the thyroid, making people feel pretty terrible and accelerate the rate of thyroid tissue destruction.

Please comment further on the use of alkaline phosphatase as indicator of zinc status - I have not heard of this before.

Low alkaline phosphatase levels are usually associated with malnutrition (nutrient deficiencies), and are commonly found with hypothyroidism and Hashimoto's. One nutrient deficiency in particular, zinc, has been negatively correlated with Alk Phos levels. Lower zinc means lower alk phos.

What causes excess oiliness on the scalp?

It could be a variety of reasons, the two main ones being androgen excess and a rebound effect from the harsh chemicals in shampoos.

What do you think about measuring Total T4 and Total T3?

Those levels may be helpful in determining the rate of binding. The free levels in the hormone are more helpful. 

What did you do to decrease your androgen levels?

My two best lifestyle strategies for reducing androgen levels are 1) increasing fiber intake, which helps to prevent recirculating of hormones and eliminates excess androgens and 2) balancing the blood sugar with eating lots of good fats, proteins and limiting carbs. Of course looking at a list of supplements to be sure patients are not taking DHEA is also a helpful first step.

Do you like Armour thyroid more than Naturoid?

I prefer Nature-Throid as it has fewer fillers and the company has tighter quality controls. People with Hashimoto's often have multiple sensitivities and are less likely to react to Nature-Throid.

Do you think desiccated thyroid (Naturethroid, Armour) is problematic for autoimmunity? Seems to be no real data supporting this long-held attitude.

I agree, it's all anecdotal information. I have seen it in some people, but not in most. I think the NDT may contain small amounts of thyroglobulin or TPO that can upregulate the autoimmune attack. I recommend testing antibodies before and after starting NDT and looking at any changes.

Have you used Spectracell nutritional testing to find nutritional deficiencies?

Yes, I have found the Spectracell nutritional testing to be very helpful. You can find the list of all the tests I recommend at 

What is your take on reverse T3 with Hashimoto's / Hypothyroidism?

Most people with Hashimoto's are going ot have a co-occuring adrenal issue and nutrient deficiency, which will prevent the conversion of T4 to T3, and promote the conversion to RT3. I don't really feel the need for testing RT3 for people with Hashimoto's, but it may be helpful for people with non-autoimmune hypothyroid symptoms.

Could you comment on whether iodine loading is needed when testing for iodine deficiency? Do you think spot urine testing is an accurate collection of iodine stores?

I prefer the urine spot test for people with Hashimoto's instead of the iodine-loading test. Iodine is a narrow therapeutic index nutrient and can exacerbate the autoimmune attack on the thyroid, making people feel terrible and accelerate the risk of thyroid tissue destruction.

I am a doctor who does hormone treatments. Have you found that using SR T4/T3 once a day in patients with Hashimoto's is not as good as IR T4/T3 twice a day due to malabsorption?

I have! The fillers used to make SR T4/T3 are often malabsorbed by people with Hashimoto's due to gut issues.

Thank you all for your great questions. You can find out more information about Hashimoto's in Izabella's book. She provides a free nutrient depletions chapter on her website, as well as a list of recommended labs.

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