Best Thyroid Doctor Ballantyne
at Novis Health

Hypothyroidism, characterized by feelings of weakness, cold, fatigue, depression and impaired memory, to name just a few of the troubles that come with this disorder, often lessen after treatment with levothyroxine or T4.  The problem is, not all of the troubles disappear, and patients are often unprepared for the lingering fatigue, lack of vitality, fleeting sex drive and potential depressive overtones.

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Studies show that physicians should counsel their patients on the fact that, while most symptoms may improve after 6 months of therapy,  they may not regain all of their vitality back and that treatment will stabilize many, but not all, symptoms and manifestations of the hypothyroid disorder. However, the study that highlighted these conclusions had many drawbacks and flaws in study design that are fairly consistent with other studies done in the same area.


What Factors Affect Quality of Life Outcomes after Hypothyroid Replacement?

According to the American Thyroid Association, the first line of treatment of hypothyroidism is levothyroxine or T4 replacement therapy. T4 is the inactive form of thyroid hormone. While 80% of this hormone is converted peripherally to the active hormone, T3, 20% of T3 must still be made in the thyroid. So, for those patients who do not have a thyroid gland, or whose thyroid gland is nonfunctioning, conversion of T4 to T3 may be compromised. In studies currently done on quality of life, all respondents were treated solely with T4 despite the fact that a large percentage of hypothyroid patients are non-responders to T4 solely and must have T3 to feel their best. So, the question remains, were the patients treated adequately?

The study states that despite 1/3 of the patients showing an elevated TSH indicative of inadequate thyroid hormone replacement, it did not correlate with quality of life symptoms. Measurements of free T3 were not done to correlate with symptoms.

Also, since we know that hypothyroidism incurs a poorer quality of life, the fact that this subset was uncontrolled per elevated TSH levels lends the question of the adequacy of the statistical design of the study itself, especially with small sample sizes.

Next, quality of life studies have uniformly been done on Hashimoto’s hypothyroidism with only T4 as the replacement therapy and no nutritional intervention. We know from other studies that Hashimoto’s patients do not generally feel well just on T4 replacement therapy, they must also follow a medical nutrition therapy diet regime.  For example, sensitivities to iodine are very common in Hashimoto’s and too much iodine in the diet can make the person feel and respond to treatment inadequately.

Individuals need to also be counseled on the avoidance of uncooked goitrogens or millet that contain a chemical that adversely affects thyroid hormone. Goitrogens such as broccoli, cauliflower and cabbage must be cooked thoroughly before eating even if you are on supplemental thyroxine. Patients with Hashimoto’s are frequently allergic to foods which stimulate the autoimmune mechanisms, one of them being gluten.  Studies reviewed mentioned nothing of dietary intervention, education or adherence.


Variables That Increase Chances of Recovery

If you are a victim of Hashimoto’s thyroiditis, remember that treatment with just T4 will probably not alleviate all your cognitive and emotional symptoms, particularly vitality, sex drive and depression. There are things you can do to increase your chances of recovery.

  1. Watch your iodine intake. The Recommended Daily Intake or RDI for iodine is 150 micrograms per day. Avoid multivitamins with iodine in them, do not use betadine ointment, and avoid seafood and foods high in iodine including iodized salt.
  2. Test for allergies. Many individuals with Hashimoto’s have allergies to gluten or dairy and other foods. The best way to test for allergies is a combination of a blood test, a skin prick test and a food challenge test all conducted in the allergist’s office. Eating allergenic foods will stimulate an immune response and an inflammatory condition which will make any autoimmune disease worse.
  3. Get adequate selenium intake. The highest concentration of selenium is found in the thyroid gland, and it’s been shown to be a necessary component of enzymes integral to thyroid function. It is a necessary cofactor to turn T4 into T3. Selenium is high in Brazil nuts, pork, ham, cottage cheese, brown rice.
  4. As many as 30% of those with a thyroid disorder have a problem with B12 absorption and/or metabolism. Getting your B12 level checked is a good proactive step in making certain your diet is optimized for thyroid support.
  5. Vitamin D deficiency is linked to Hashimoto’s, according to one study showing that more than 90% of patients studied were deficient. However, it’s unclear whether the low vitamin D levels were the direct cause of Hashimoto’s or the result of the disease process itself.
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Get adequate emotional support from a therapist or doctor who can help regulate rampant neurotransmitters so unpredictable in Hashimoto’s thyroiditis. Early intervention can help support emotional issues that may zap the quality of life out of even the most well-adjusted individual.


So what if the studies say that treatment may not increase the quality of life to what it was before hypothyroidism kicked in? It does not mean it will be that way for you. Explore your other options. Ask for T3 if you think that might help. Find out your food allergies. Supplement when needed.  Follow a good diet. Think positive. Get emotional support. And, grab that quality of life back!

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