Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
15 Jul

A Different Perspective on Hypothyroidism

Hypothyroid has been covered to death before. I’m particularly fond of The Healthy Skeptic’s coverage – check out Chris Kresser’s ongoing series (possibly before you read on) for some great information on the thyroid. Carnivorous Danny Roddy did a good piece on it last year as well. As such, I won’t be redoing or rehashing an “intro to thyroid.” Instead, I’ll give a brief overview and then discuss why I think some of us may be looking at thyroid “dysfunction” in the wrong light.

The thyroid is a complicated little bugger wielding a lot of influence over the metabolism, and it seems like just about anything has been fingered as a trigger of its dysfunction. Lack of carbs in the diet, too few calories, too much iodine, too little iodine, too many grains, intermittent fasting, excessive cortisol, and multiple other factors have gotten the blame. Unraveling the multiple potential triggers for its dysfunction can be tough. But is dysfunction always the right way to describe a slight reduction in thyroid hormones? I’m not so sure.

In clinical cases of hypothyroidism, elevated levels of thyroid stimulating hormone (TSH) indicate that the thyroid is no longer producing enough thyroxine (T4) and triiodothyronine (T3). Further tests of T4 and sometimes T3 can confirm it. Metabolic rates slow down. People gain weight and can’t ever seem to get enough sleep or get warm enough, especially in the extremities. Blood lipids increase and often worsen, and some cases even develop into emotional depression. If hypothyroidism gets really extreme and is allowed to progress unabated, hair loss, impaired memory/cognition, face puffiness, and numbness of the arms and legs can occur. Now, don’t get me wrong. These are terrible, frustrating symptoms for someone to deal with, and clinical hypothyroidism is a real problem, one that can be mitigated or treated with pharmaceuticals. I’m not trying to discount that. In fact, let’s take a look at the most common form of hypothyroidism: Hashimoto’s thyroiditis, an autoimmune disease responsible for around 90% of hypothyroid cases in the United States. People with Hashimoto’s produce thyroid tissue antibodies that compel the immune system to wage war on their thyroid glands, destroying the thyroid itself. Without a thyroid gland, you can’t produce thyroid hormone. Without thyroid hormone, you’ve got hypothyroidism. That’s a serious problem.

(Side note that probably deserves more attention: Whenever I hear the word “autoimmune,” I immediately think of gluten, lectins, saponins and other gut irritants. I’m inherently suspicious of their role in human health, but when it comes to autoimmune diseases, I’m downright accusatory. Sure enough, Hashimoto’s thyroiditis patients are more likely to be celiacs, and abstaining from gluten for the purpose of reducing anti-gliadin antibodies also seems to reduce thyroid-specific antibodies. As Chris mentions, Hashimoto’s appears to merely be a part of a wider “polyendocrine autoimmune pattern” characterized by the presence of antibodies for multiple tissues and enzymes in the body.)

But what if “mild” hypothyroidism isn’t such a bad thing for those of us without Hashimoto’s? It manifests as a down regulated metabolism, a depressed energy output – a slowing down of sorts. Everything slows. What if slowing things down for a bit actually helps increase health?

As for general complaints about hypothyroidism due to some lab results, I’m always wary of folks determining their sense of health based on how their numbers compare to “normal” test results (remember my blood pressure experience?). Everything is relative; your numbers are being compared to millions of other numbers derived from a population eating the SAD, leading stressful lives, and following the modern, misleading CW. Is this population normal? Sure, using the strict definition. Is it healthy? No, and I think that calls into question the validity of comparing your numbers to theirs and using that comparison to determine which drugs to take.

You may have heard of the calorie restriction set, with their CRONometers and their fervent desire for life extension. It’s not a lifestyle I’m necessarily keen on, but the concept of calorie restriction as a life extension technique does have merit – plenty of studies show extended life spans in CR animal models, like monkeys, rodents, worms, and flies (a pretty diverse cross-section of life, I’d say) – and it’s always smart to pick and choose from what works and what does not, regardless of the source (this isn’t religion, folks, and dogmatic purity doesn’t matter when you’re just trying to get healthy and live well). Caloric restriction lowers circulating T3, which is the active, “potent” thyroid hormone that (for our intents and purposes) controls the metabolic rate. Low T3, lower metabolism, potentially greater longevity (since you aren’t “burning” as bright, so to speak). All good, right?

Sort of. Those rats, monkeys, and worms were having food withheld. They weren’t consciously deciding to restrict calories, and even though they were living longer, disease-free lives, they began to show signs of clinical depression. Humans do the same, as anyone who’s examined the results of Ancel Keys’ starvation study or dealt with a hungry, cranky spouse can attest. Nobody wants to restrict calories.

Intermittent fasting has been proposed as an effective way to get the benefits of caloric restriction without the actual restriction. Intermittent fasting certainly has some similar effects on the body. Like CR, IF reduces circulating T3 – but T4 normalizes. Like CR, IF likely improves age-related degradations in worms, rodents, and humans. It has the effect of spontaneously lowering caloric intake without much effort (eating Primal has the same effect on satiety), and many of the benefits attributed to both CR and IF are associated with thyroid hormone levels that approach “mild hypothyroidism.” Hyperthyroidism, on the other hand, has the potential to shorten lifespan.

I’m just speculating here. Others, like Nora Gedgaudas, have suggested that a mildly hypothyroidic state might actually be physiologically “normal” and optimum for longevity. It makes sense, intuitively.

In the end, I’m all about subjective results. How are you feeling? Are you gaining weight? Are you fatigued? Or are your lab numbers just telling you (or your doctor) that you should be experiencing these symptoms? Listen to your body. If you’re experiencing the clinical symptoms of hypothyroidism, if you’re falling asleep at your desk and gaining weight and just generally feeling like crap, you’d listen to your body and get your thyroid checked, wouldn’t you? Just make sure you don’t ignore your body if it’s telling you good things, too, and don’t let some mildly “irregular” numbers override your intuitive sense of well-being.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. i hear turtles are delicious as a soup.
    i had the sleeping always tired, gained 25lbs in one year. i was probably experiencing those symptoms without even knowing it. on a side note…i think it could have been caused from my addiction to bread pudding with praline sauce and buttercotch icecream…

    earthspirit wrote on July 15th, 2010
    • lol someone got rid of the turtles remark first comment. well that makes my comment make no sense at all!

      earthspirit wrote on July 15th, 2010
      • Perhaps you could try a turtle bake. Turtles by the bucket can really fuel your hambone reactor.

        Turtle Man wrote on October 29th, 2015
  2. I have been hypothyroid (and hypogonad – low testosterone) for 12 years. I gained 70 lbs in 3 months before my TSH “normalized.” To this day I am still having symptoms. We increased my Synthroid medication, we’ve lowered it. I’ve increased exercise (P90X), decreased it (Grok-style)… increased calories, decreased it (IF made things worse)… I live a healthy lifestyle, probably mid 90% Primal. I’ve even lived like I had Celiac Disease for 8 months (restaurant managers treat you different when you ask for no bread/grains due to an “allergy”). I cannot find an answer. I just left a message with an Internist’s office. I don’t know what else to do! I feel like crap! But I still like wearing my Five Fingers! 😉 I love reading MDA each day. I have sent a couple emails to Mark over the last year or so. You guys are incredible. Thank you for so much insight!! – Dan

    Dan Seidler wrote on July 15th, 2010
    • Dan, I suggest you look up the work of Datis Kharrazian. He teaches courses in functional endocrinology and practitioners who have been trained by him know which tests to give you to figure out your personal endocrine puzzle.

      I also urge all of you with Hashi’s to look into Kharrazian’s work. You have an immune system issue, first and foremost, which needs balancing (the thyroid being attacked is just collateral damage) and taking thyroid meds just masks the damage that is still occurring and does not address the real underlying issue.

      You need to find out which pathway of your immune system is overactive and control it and once this is achieved and the attack stops, most Hashi’s patients are able to discontinue their meds (unless their thyroid has been severely destroyed already).

      Erin wrote on July 15th, 2010
      • Erin is right on. I’m one of the doctors trained by Dr. Kharrazian, and his approach to the thyroid truly is cutting-edge stuff. Many, many people have been helped with this approach.

        If you are having thyroid symptoms, even if your labs look “good,” or even if you are already on a prescription, I urge you to read Dr. Kharrazian’s book and to find one of the doctors he trained near you. TRAVEL to one if you have to. I’m in Texas & happy to help. :-)

        Dr. Carpenter wrote on February 16th, 2011
    • My wife has hypothyroidism and was on synthroid which did not work for her. However, Armour Thyroid has worked very well, it is made from pig thyroid. Ask your doctor about trying it.

      Chad wrote on July 16th, 2010
    • Dan
      Have you had your frees tested -T4,T3? Are they midrange? Since you have low testosterone, have you considered the possibility of hypo-pituitarism?

      marcadav wrote on July 16th, 2010
      • Though I haven’t had them tested in the past year, I have had all the other levels tested – they were all “normal.” I had a radio-active MRI done to check my pituitary and hypothalumus. (twice, actually) – no tumors.

        As for Armour, none of my doctors will prescribe it… I have switched doctors on several occassions due to lack of progress. I am currently in the market for a good Internist…

        Fantastic posts, guys. Thank you all so much!!

        I will have to look in to Kharrazian’s work. Thank you! – Dan

        Dan Seidler wrote on July 22nd, 2010
    • Why are you on synthroid? The internet is full of storys relating to being mistreated with synthroid. Lots of good storys about natural dessicated thyroid derived from pigs though, sounds more primal to me :-) I read a very good book by Mark Starr about thyroid health, covers heaps of info. I hope you are getting to the bottom of your health issues and best of luck to you.

      Nicole wrote on May 28th, 2011
  3. i really stuggle with this feel like crap most of the time,struggle to lose weight ,workouts are hard to keep going,its a night mare ,i take a high dose of thyroxine 275 mm Help :(

    gijive wrote on July 15th, 2010
    • @ Dan & gijive – I was still having problems while on synthetic replacements (Synthroid, levothyroxine) but have found much relief when I asked my endo to prescribe desicated thyroid for me. I take Armour thyroid and it has done the trick. It is a combination T4 & T3 medication. It can be a chore to source each month will calls to several pharmacies in the same chain to check availablity but at least I have always been able to get it. I would recommend it, it has given me my brain clarity and energy back.

      TexasPrimalSurfWahine wrote on July 15th, 2010
  4. I was diagnosed with Hashimoto’s about 10 years ago. And following right along with that, I am very gluten intolerant. I may be Celiac, but I have never tested for it. Once I went Primal and cut out grains, that was no longer a problem for me. I have lost 40 lbs since then, and at my latest exam, my doctor lowered my dosage. He said it was simply a matter of losing weight. I think that it’s also partly because I stopped eating grains.

    Katt wrote on July 15th, 2010
  5. I have both Hashimoto’s hypothyroidism and celiac disease and have been on (natural, porcine) thyroid hormones for the past four years, which have brought my TSH, T3 and T4 into “normal” range. Of course my antibodies remain sky high. I have been as close to primal as possible (I indulge my sweet tooth with dried fruits more than is strictly primal, but not by much) for over two years and I practice intermittant fasting. Despite the lifestyle changes – and don’t get me wrong, my I do feel better than I did before my diagnoses – I still feel way too tired and sluggish in my daily life. And my sleep is absolutely horrible (chicken/egg, I know).

    I’m beginning to look seriously at candida as the underlying cause (or exacerbating factor) of my health issues. I don’t know that I can handle any further restrictions on my already restriced diet, though. My God, no fruit!?! I mean, I’m primal and I believe in it, but I enjoyed life so much more with lasagna and ice cream…

    Anyway, I know Mark has covered candida before, but it would be great if he could tie it into his discussions of autoimmune disorders as well as share his thoughts on they myriad versions of the “candida diet” out there.

    G.G. wrote on July 15th, 2010
    • There’s actually a lot of interesting ideas out there about curing candida with a high fruit diet. I admit it’s mostly the vegan types who promote that kind of cure, but it’s something to contemplate.

      Elizabeth wrote on July 15th, 2010
      • How exactly would that work? What’s the science behind it?

        mm wrote on December 19th, 2010
    • You could probably tie Hershi’s to Celiac to damaged gut lining and one’s gut flora being out of whack: Candida.

      Probiotics, ditch the grains, fungus foods, focus on building good gut flora etc. Maybe Mark has a post of gut flora?!

      Madelain Burgoyne wrote on July 29th, 2013
  6. Thanks for this, Mark. Although I’ve always struggled with weight issues and would love to “blame” hypothyroidism, I too have long thought that intuitively, a slower running metabolism seems like it’d be better than one running hot. Not scientific at all, just seems like if you run slower, you live longer. :)

    Andrea wrote on July 15th, 2010
  7. I have Hashimoto’s, and am pleased to report that a few weeks ago I had my TPO antibodies (the marker for the autoimmune disease) tested for the first time since I was diagnosed three years ago. I’ve been low carb/grain free/increasingly primal for most of that interval. Well, on the recent test the antibodies are not active at all (normal is <20, mine were <10). I pretty much credit the diet for that!

    Don't know that I'll be able to reduce medication — just over a week ago I had half my thyroid removed for a large nodule associated with the Hashimoto's that showed inconclusive results on my last biopsy (it did turn out to be benign). But that's not much of a problem to me — I'm VERY happy to know the autoimmune process itself is quiescent now!

    Anne wrote on July 15th, 2010
  8. Thanks Mark – this is a very interesting perspective. I have been hypothyroid for most of my life, yet active and never overweight. My husband notices that I tend to get a bit “depressive” and lethargic when my thyroid is low (he notices the symptoms before I do, but when tested, he is right), and a low dose helps. But, I sometimes wonder if I really need it, or if I can get past this on my own. I lived for years without the medication and was still highly active, so who knows!

    Alisa - Dairy Free wrote on July 15th, 2010
  9. I am 30 years old and have had hypothyroidism since 7th grade. I was active person and a healthy eater. Hypothyroidism runs in my family. I experienced depression, extreme tiredness, hair loss, and weight gain before my diagnosis was made. All of which are hard on an adult, but even more difficult on a teenage girl. I was put on a low dose of Synthroid and many of my problems did subside. If I am reading the post correctly it seems as though you are suggesting that having a slightly dysfunctional thyroid could be a good thing? I assure you, it isn’t. You feel like crap. It cannot be controlled by diet.

    As I said before, my symptoms never truly corrected themselves even with the Synthroid but my “numbers” were always within the appropriate range. Here is where we agree. Numbers are not what you should rely on alone. Finally I went to a Endocrinologist and not just my family practitioner. He told me that while many women have a “normal” TSH level, that they still feel symptomatic. His philosophy was to increase the dosage of medication until I FELT better. I did this and amazing things happened. Gone was my need for an afternoon nap, my hair was thicker and shinier, and most importantly after struggling to get pregnant my husband and I conceived. It was also key that I was actually on brand medicine. I’ve worked in a pharmacy before and I know that generic meds on the whole are exactly the same as their brand counterparts, however some are not. Synthroid isn’t.
    “Mildly irregular numbers” can work both ways.

    Laura wrote on July 15th, 2010
    • I have to agree with Laura on this one. Hypothyroid is an extremely misunderstood disease, I’ve had it since I was 15 years old and I still don’t understand all of it. I wouldn’t play around with mild hypothyroidism, it will cause you a lot of unexplained lethargy and other bad feelings. You’ll be desperate to know what is wrong and nothing you’re doing will feel like it’s helping. Even with meds levels are slow to change so it can be quite frustrating while you wait – then one day, finally, the water weight will start coming off and your energy will start coming back and you’ll feel like a new person. You’ll never want to go that road again, even “mildly.”

      SK1 wrote on July 15th, 2010
      • Did you guys skip the part where Mark said PB’ers are only mildly hypo on paper but are asymptomatic? Or even all of those success stories of people talking about how much more energy they have? Or how eating paleo reduces inflammation disorders and gives your adrenals a break from all of those sugar crashes?

        mm wrote on December 19th, 2010
        • Paleo made me feel a lot worse. I am a long time “only mildly hypo” sufferer. Occasionally more tired than I should be in the afternoons, occasional body temp fluctuations. Otherwise fairly healthy. I finally decided to try the lowest dose of synthroid and honestly it really made me feel a lot better. I’m not discounting other peoples experience. Everyone has to figure out what works for them though.

          Turtle Man wrote on October 29th, 2015
    • Yes, yes, yes to everything Laura said.

      Who cares about living a longer if you feel terrible all the time? I usually agree with you 100% Mark, but as someone who finally got a hypo diagnosis after much grief and anguish (three years of depression, losing my hair, and gaining fifty pounds) I gotta say on this one? No. Way.

      By the way, my numbers always fell in the normal range. I didn’t get a diagnosis until I started to develop a visible goiter. So I agree with not living by the numbers, but I’m coming at that from the opposite direction.

      Lydia wrote on July 15th, 2010
      • I second this. I definitely don’t want to live an extra twenty years if I have to have cold hands, depression and lethargy. In fact, get depressed enough and you won’t want to live to see tomorrow, nevermind fulfilling some kind of superhuman lifespan. Living should be defined as feeling great and functioning well, not duplicating some lab results with animals that have a brain the size of a pinhead.

        Elizabeth wrote on July 15th, 2010
        • Thirded. Most hypo patients feel best when their numbers are towards the hyper end of things. If I had to live in the upper range towards being hypo instead of hyper, I wouldn’t want to live the extra ten or twenty years.

          Willa wrote on July 18th, 2010
    • I also agree with Laura. My story is a lot like hers — I was a teenager, and my numbers were within “normal” range, so it was only when I saw an endocrinologist that I got a diagnosis.

      I had successfully fought the weight gain through restrictive diets and desperate exercise, and guess what, that did NOT improve my symptoms — I was still cold all of the time (to the point where my hands were sore from the cold), tired, having trouble digesting food, and out-of-it. I don’t know where I’d be without Armour thyroid. Just one anecdote that stands out in my memory: a week or two after I started taking Armour, I remember going to my CD collection to pick out some music to play, and realizing as I brushed away the dust that I probably hadn’t played music for more than a year — it just hadn’t occurred to me while I was a hypozombie.

      I hate being on medications, and I tried going without it once, under a doctor’s supervision — that didn’t go well. If the slowing of the metabolism brought about by hashimoto’s were anything like the effects of fasting, I’d be all for it. I love the feeling of being on a fast. But that’s not at all what it is like.

      So I agree that you shouldn’t rely on the tests, but if you test low and you feel fine, it’s because you’re not really hypo — not because being “a little hypo” is okay!

      One final comment on taking hypothyroidism seriously — don’t tolerate “mildly” low thyroid levels if you’re pregnant!

      Sarah wrote on July 24th, 2010
  10. thanks..the only thing i’d say is that intuition can be spectacularly wrong or right.
    Did you read Myers book Intuition its powers and perils .. a brill read..very sobering

    Simon Fellows wrote on July 15th, 2010
  11. Mark,

    Our circadian rhythm must be set every day in unobstructed morning light,in order for our body to have optimum physiological functions … including thyroid function.This is basic to health, and should be the starting point to any discussions on health … and it doesn’t cost anything to do. The question is, why is it so neglected ?


    Marc wrote on July 15th, 2010
  12. I was diagnosed with hypothyroid about four years ago. My numbers were borderline, but my naturopath treated my symptoms. It’s made a *huge* difference in the quality of my life. One thing that we quickly learned is that while Synthroid and a “natural” compounded mix may keep my numbers in line, the Armor, porcine stuff is the only one that keeps my symptoms away. So I agree wholeheartedly that numbers don’t tell the entire story: treat the symptoms.

    rozska wrote on July 15th, 2010
    • After five years on levothyroxine, I became symptomatic again in March. After several months of fooling around with different dosages, my doctor switched me over to Armour at my request. I’ve been on it for three days. Here’s hoping.

      I admit I’m scared. I don’t want to get trapped in that downward spiral again. It was hell. I’m glad to hear another vote for Armour. It makes me feel a little better.

      Lydia wrote on July 15th, 2010
      • I think youll like the Armour brand, its actual thyroid hormone, not some man made knock off.

        Ive been on it for a couple years, who knows i might not even need it anymore. All i know is that i felt a difference immediately…like within a week. No more brain fog, no more wanting to take a nap at 1pm. Gaining weight is no longer a problem, keeping it on is.

        My doc tried Levothyroxine on me when there was a shortage of Armour. I did NOT like that stuff. Within 5 days i had sore/swollen throat to the point where i was contemplating going to emergency. I called the doc and he told me stop taking it immediately. Apparently the proper pharmaceutical dosage of this stuff, for it to be effective, is also very close to a toxic dose.

        Armour is easier to play with dosage wise until you find the right one, being natural thyroid hormone.

        Shawn wrote on July 15th, 2010
  13. “get your thyroid checked”

    If only it were that simple. Almost all docs only treat by lab numbers, not symptoms: “here sweetie, your thyroid number is fine, have an antidepressant”! {eye roll}. Most docs only test the TSH — thyroid stimulating hormone — which is a pituitary hormone, not even a thyroid hormone. The example I always use to explain the problem with that is as follows.

    The farm wife yells out the window that supper is ready. (The pituitary ‘shouts’ to the thyroid to make some T4, the storage hormone that must still be converted to the biologically active form, T3. God help you if your body can’t or won’t convert T4 well.) (Note that Synth”crap” is T4 only — so if you don’t convert, you’re NOT being treated!)

    The TSH test is read by the doc to say: CLEARLY the farm hands have been fed, because she yelled to them. (“Your TSH is normal — your weight gain, hair loss, exhaustion, the loss of the outer third of your eyebrows (!), chilliness, etc. is all in your head. Here, have an antidepressant!”)

    The problem? The TSH gives absolutely NO idea whether or not the thyroid actually GOT the message (the farmhands heard her), whether or not the thyroid was able to produce the T4 (the farmhands came in for dinner), or whether the body was able to convert the T4 storage hormone into the *active* T3 hormone (the farmhands actually got some food).

    There is a forum/website called Stop the Thyroid Madness that provides actual information based on hundreds, if not thousands, of folks who have discovered what actually works, (including some doctors and nurses who have gone beyond what Big Pharma says). I’m not associated with that site, except having had my life and sanity (and thyroid!) saved by the information there.

    (Oh, and most docs will also test your Free T3, and (if you do) tell you that you have “enough” (or even “lots”) so you’re fine (“so, here’s another antidepressant”); except your CELLS may not be getting any T3, the T3 may be pooling in your blood stream — which is no use.)

    This is a field where self-education is necessary.

    Elenor wrote on July 15th, 2010
    • Thanks for your response and for including information about STTM. I have alot of respect for Mark Sisson and his PB but thyroid issues are complex and totally out of his realm. I cringe when I read blogs like this. There are literally thousands and thousands of people who have had devestating health consequences from misdiagnosed and undertreated thyroid problems. The thyroid and thyroid hormones affect leterally every cell and system in the body. Any one who even THINKS they might have thyroid issues, I urge you to check out the Stop the Thyroid madness site and to join the thyroid and adrenal support groups on yahoo. These people really know their stuff. Most Dr.s and endocronologists don’t have a clue how to treat this problem but there are some out there who do and these sites can help you find one. Thanks!

      teri fout wrote on July 16th, 2010
  14. Nice to see a plug for the Healthy Skeptic Blog. It’s yet another wonderful resource for those of us floating around in cyberland. Chris Kresser knows his stuff.

    Maria wrote on July 15th, 2010
  15. Perhaps, being a Primal-dabbler, and not fully accustomed to your
    writing style I’m taking this wrong – but as a symptomatic Celiac with
    friends with hypothyroidism, Hashimoto’s, and a cousin with an
    autoimmune disease that is slowly killing her – I’m a little offended
    by the tone of this post. What you’ve written makes all of these very
    serious, sometimes deadly diseases, sound like minor annoyances. It’s
    agonizing to have a body hell-bent on slowly destroying itself. Please
    be cautious when posting advice about health topics that go beyond
    basic nutrition and fitness. Suggesting that a disease is to the
    benefit of humanity does no favors to you, your readers, or the
    concept of Primal Blueprint.

    M'chelle wrote on July 15th, 2010
    • Agree, I was rather offended when I first read it, but usually I am not offended by your posts, Mark. I think the tone of the autoimmune sidebar is rather confusing.

      Anonymous wrote on July 15th, 2010
      • I took it entirely differently. From what I could gather, Mark’s saying that hypothyroid is a serious disease with some devastating symptoms, but if you feel fine, don’t jump to conclusions and freak out if some test numbers come back a little lower than you expected.

        For instance, a lower carb diet and intermittent fasting can both lower thyroid hormones; absent any symptoms, is that a problem?

        Erik wrote on July 15th, 2010
        • “For instance, a lower carb diet and intermittent fasting can both lower thyroid hormones; absent any symptoms, is that a problem?”

          I would personally say no, absolutely not a problem. The problem is if you start experiencing negative symptoms but ignore them because you’re boxed in by preconceived ideas of a “perfect” diet.

          Elizabeth wrote on July 15th, 2010
        • That’s how I read it, too — prefacing everything about how real and bad those hypothyroid conditions are, as a contrast to what he’s actually talking about which is very mild / slightly low metabolism.

          Jen wrote on July 16th, 2010
        • I was one of those folks who felt fine with slightly skewed labs for quite awhile. But untreated hypothyroidism can have devastating affects on health. Even “subclinical” hypothyroidism. One minute you are ok, the next minute you aren’t. It’s not quite as simple as that, but you get the idea. I’ve eaten a low carb diet for years and have just recently (in the past 5-6 months) gone more primal with IF because I was getting frustrated with no weight loss, and inexplicable weight gains. I’m not saying that change suddenly made me ill. But I do think it was part of the “perfect storm” that took my cork under. Thyroid disease is rampant and the majority of doctors really don’t have a clue what they are talking about or how to treat it properly. Endos are notoriously the worst of this bunch! They get all their info from the drug reps who push the synthetic CRAP that the drug companies can make $$$$ from at the exense of our health. We all know how well THAT works.

          My whole point is people who don’t really have a good grasp of thyroid disease should stick to what they DO know. I just cringe reading some of these posts too. Especially from people who think they will cure their thyroid disease with a primal lifestyle or that think that their case is “mild” and decide to stop their thyroid meds. That is SO dangerous.

          teri fout wrote on July 17th, 2010
        • Exactly how I read this post – don’t freak out if the numbers come back a little outside “normal”. When researching the hypothyroid issue even what’s considered “normal” is up for debate.

          Matt C wrote on September 17th, 2010
        • agreed. Thanks Mark.

          hogbackmts. wrote on July 5th, 2016
  16. :-) complex subject, indeed!

    i was diagnosed hypothyroid at just a few months of age, and that was half a century ago. all my life i’ve been on thyroid of one kind or another, so believe me, i have a LOT of experience of good doctors and bad, good medicines and bad….

    i second the recommendation to access!!! YES, hypothyroidism is nothing to treat lightly, but NO, do not rest your fate in the hands of conventional medicine! educate yourself!

    with the recent “shortage” of natural thyroid (Armour), i had to start tweaking my treatment, and between adding IRON to my supplements (check out ) plus selenium, more magnesium and zinc, and T-100, i feel GOOD. i’m sure that dropping grains and managing stress are also EXTREMELY important.

    like Mark says — *listen to your body*.

    tess wrote on July 15th, 2010
  17. it’s interesting that although the Healthy Skeptic writes that there are many pathways to hypothyroidism, most of his recommendations are based on the Hashimoto’s kind…. he says (in bold-face type, no less) that hypothyroidism is an autoimmune disorder, which isn’t ALWAYS the case. SOME of us definitely benefit from nutritional supplements.

    tess wrote on July 15th, 2010
  18. As a cancer survivor, I have been told that radiation has severely destroyed my thyroid. I have been 90% primal for the last 2 years with no change in my TSH levels. I fast once a week, sometimes more. I have not succumbed yet to meds, but I may have to.

    Abby wrote on July 15th, 2010
    • I am new to this site, just thinking of exploring the primal life and would like to know how you are doing with the primal diet and hypothyroidism. I too am a cancer survivor with a radiation destroyed thyroid. I have gained 45 lbs since and would like to chat with someone who has some of the same situation as me health wise. I also struggle with depression and fatigue and definitely an emotional eater.

      Kim wrote on September 6th, 2014
  19. I was diagnosed hypothyroid a few years ago after a blood test. Not knowing any better I put myself in the hands of an endocrinologist even though I felt fine, had no significant weight problem, etc. At the time I was still eating a grain and legume-based diet and drinking a lot of beer. Today I’ve been pretty much primal in diet and exercise for about a year, feeling fit and strong at 57, (6’0″, 165, doing level 7 on but I’m still taking 125mcg. of Levoxyl every day. So I’ve decided to wean myself off it slowly while closely monitoring my performance in terms of weight lifted, workout times, and how much work I’m getting done in my job. If anyone has any advice about this weaning process (especially you, Mark) I’d love to hear it. Wish me luck.

    Kevin wrote on July 15th, 2010
  20. Typo correction:, not super, which by the way is an outstanding simple program to satisfy the “lift heavy things” recommendation.

    Kevin wrote on July 15th, 2010
  21. Great post! Something intelligent about thyroid — what a relief. I’m going to go look at those other sites.

    I always wondered about thyroid CW but was way too discouraged by my experience with conventional medicine on it that I just came to ignore anything I read about thyroid. For instance, I used to take kelp pills — I’m sure I was getting less iodine out of them than the average Japanese. Doctor I was seeing at the time said, “No! Don’t take those! It will suppress your thyroid. ” Huh? But, I did what I was told.

    slacker wrote on July 15th, 2010
  22. Thanks for the tip on Datis Kharrazian…….I have Hashimotos and have taken thyroid replacements but never felt any better or lost any weight. I had given up for now on dealing with this so I’m glad to have this lead on new info.

    Brenda wrote on July 15th, 2010
  23. I’m on day three of changing to a paleo diet. I just turned 45 and had a list increasingly disturbing symptoms including morning pain and overwhelming fatigue, which I was starting to put down to my age, even though this has been going on for over a decade. The doctor told me my blood showed low T4, high TSH, so “we might put you on a tablet”. Why am I low thyroid? “It just happens” (Thanks for the deeply researched answer, doc).
    After a frenzied but very focussed session on the internet I put it all together and have banished those grains and dairy products! And I already feel much, much better. My hopes are high that I’ll be able to take up some running soon.

    scotsgirl wrote on July 16th, 2010
  24. Slacker wrote: kelp pills — I’m sure I was getting less iodine out of them than the average Japanese. Doctor I was seeing at the time said, “No! Don’t take those! It will suppress your thyroid. ” Huh? But, I did what I was told.

    It’s not actually that simple: one school of experience says even folks with Hashi’s can take iodine; another school of experiences says not to. There are two concerns about Kelp pills: 1) they are variable in their iodine levels and 2) some seems to contain arsenic!

    I started my return-to-health journey using Iodoral — the OTC iodine/iodide pills — and the first day, a brain fog I did not even know I was under lifted! Whoo-hoo! However, five years on, I am now not taking Iodoral because I am on T3-only pills to remove the (inactive) reverse T3 that has built up in my system, preventing the T3 from getting into the cells. The Idoral/iodine encourages the thyroid to keep producing T4, which is converted in to more rT3.

    This is not a simple field with a one-size-fits-all diagnosis and treatment. And alas, almost without exception, you cannot trust your doc to know what to do (and not just “if” but **especially** if s/he is an endocrinologist — talk about drinking Big Pharma’s koolaid!! Downright dangerous!)

    Treating your adrenals is almost always necessary in order to treat your thyroid. I can’t recommend highly enough the Stop the Thryoid Madness site to learn all the stuff your docs were never taught — and to counteract the idiocies that Big Pharma has taught them!

    Not as easy as just lying back and letting your doctor do whatever — but much more likely to get you back to health! (After 8 weeks on T3-only, I’ve suddenly lost 8 pounds in the last two — after not being able to lose weight at all for years!) The “time to complete clearance” of the rT3 (out of their blocking of active T3 from the cell receptors) is around 12 weeks (as determined by the hundreds of folks who’ve done it through the advice on STTM), so I’m looking forward like you can’t imagine to see how I do when my metabolism is finally freed!

    Elenor wrote on July 16th, 2010
  25. I’m also of the opinion that lab numbers are not an indication of health, but when it comes to hypothyroidism, as has already been mentioned, most people have normal lab results and experience symptoms-not the other way around. Suffering from low FT3 feels terrible. I barely have energy to play with my 2 yr old. My whole body often feels limp. This despite eating primal for 6 months. The only thing that gives me energy these days is creamed coconut. I don’t want to live a long life if it’s like this… luckily I’ve found a good doc who listens…

    Jessica Slattery wrote on July 16th, 2010
  26. why did you banish the dairy?

    Mallory wrote on July 16th, 2010
  27. I just ordered the PB book and found MDA a couple of days ago and this is the first post I have read. I have to say I am disappointed.

    Hypothyroidism is NOT something to make light of. It is a serious and debilitating condition that often goes undiagnosed (or more commonly MISdiagnosed). It is pretty difficult to get tested and treated PROPERLY when you ARE hypothyroid, I can’t imagine there is much of a problem with asymptomatic people having meds passed out to them.

    Like other people said, the TSH test is almost worthless to detect thyroid problems. TSH is a pituitary hormone. It has to go through multiple conversions before it reaches a state that can be used by our cells. There are many ways those conversions can go wrong and go undetected by the TSH test and leave your cells without vital thyroid hormones (Like one of the other responders said, one of the problems is T4 to T3 conversion. If you have a conversion problem, most of the commonly prescribed meds will not help or make you feel worse).

    We do agree that test “ranges” should not be used to diagnos and treat hypothyroidism. Each of us has our own range where we function and feel good that has little to do with the lab ranges that come back with our results.

    What usually happens is a patient goes in complaining of fatigue, weight gain, brain fog, hair loss, cold all the time (these are just the biggies, there are many more symptoms), the doctor does a TSH, and if he is enlightened, a couple of other tests. The tests come back “in range” and then the patient is told, “Your thyroid is normal. You eat too much and are depressed.”

    The analogy I like to use to explain this process is… Imagine you have a Honda sedan. You have been driving it for years. Runs smooth and gets 30 mpg. All of a sudden it runs rough and you are at the gas station twice as much. You take it to your mechanic who checks to make sure there is no blockage in your fuel line and tells you, “Your car is getting 15 mpg. The fuel efficiency range for vehicles is between 12 and 50 mpg. You car is in range so you don’t have a problem. Don’t carry so much in your trunk. If you still have a problem, take an antidepressent.”

    Gina wrote on July 16th, 2010
    • I know this is an old post, but have to comment! Your analogy is by far the best I have ever read. I don’t want an “in range” life, I want an optimal one :)

      TC wrote on May 5th, 2013
  28. I have been taking Synthroid for 30 years. I have seen several GP’s & Endocronoligists. They all seem to throw a dart at the dosage dart board to get my numbers right. Even lowering the dosage & taking 1 extra a week (effectivley taking the original dose per week) & it fixing my numbers. Is it a pipe dream to think that by being primal I have a shot of getting off of that medication? I have kicked all other meds by losing weight (cw), but now I am 14 weeks primal, & plan to see my GP in about a month. Anybody ever correct the problem with healthy living?

    STEVE wrote on July 16th, 2010
  29. Just a warning for all of you that are thinking you might be hypothyroid…you might not be! I spent three years being tested for thyroid because of on going problems and it finally took a trip to the ER late one night to find out I’m hyperthyroid not hypo! I still had many of the same complaints (energy issues, hair loss, weight, depression, etc) of hypo along with the racing heart and uncomfortable feelings in hot and cold weather. It took several doctors to finally find one that knew what he was doing after the ER trip.
    Doc’s best advice to me was ANYTIME that you have hormonal changes your body will tell you with any combination of symptoms. Those “textbook” answers of what fits with what should be thrown out the window when dealing with thyroid. If you notice changes in weight, skin, hair, moods, energy, ect those are usually the first signs something is off. I had many of the “textbook” symptoms of low thyroid but ended close to having a thyroid storm (extreme hyper and extremely dangerous) because of other docs lack of knowledge.
    Start asking anyone around you about endocrinologist and you will hopefully find one with a big following because of his/her success rate in helping patients. That’s how I finally found a good doc. Like many of you my previous docs were blaming everything on age, depression and tried to tell me it was all in my head and just take these depression/anxiety pills.
    My doc also told me that many people with grain issues end up with thyroid issues, both hyper and hypo. In the end I ended up having to have my thyroid ‘nuked’ and rely totally on replacement for my hormones. I often wonder if I had cut out the grains long before the thyroid symptoms started if I would have ended up having to have my thyroid killed off….if only I had a reliable doctor back then I might have had different outcomes!

    Cassandra wrote on July 16th, 2010
    • I wonder the exact same thing. I had the radioiodine for graves’ disease 4 years ago and now I’m hypo and not sure which is worse! I really wish I would’ve had the information on grains that I have today. :(

      Lee wrote on July 18th, 2010
    • There is an excellent article from Dr. Mercola on thyroid dysfunction and some ways to manage it naturally with coconut oil of all things. There was feature about that in Womens Day in 2003 as well but there are plenty of resources and testimonials about it online as well.

      Nomad Foods wrote on May 4th, 2011
  30. First, most diagnostic tests look for the outliers, the clinical picture, not the subclinical one. I would argue that addressing JUST the thyroid without regard to any of the other glands is erroneous and, possibly, dangerous.

    The thyroid is not the most important regulatory gland in the body – there isn’t a master gland (though if I had to pick one, it would be the pituitary). The thyroid works in conjunction with the other glands. Remove any one of the endocrine glands and you’ll see cascade effects all over. However, it is pretty clear that the adrenals are probably more of a basal regulator than the thyroid. I would also argue that it is necessary to first address adrenal problems before attempting to improve thyroid function; it is likely that thyroid function will follow along on improved adrenal function.

    jennifer wrote on July 16th, 2010
  31. very nice article on hypothyroidism and i would like to recommend this page for people looking for info on hypothyroidism !kudos for you for elaboratinh things easy !

    Health Articles wrote on July 16th, 2010
  32. Jennifer wrote: it is likely that thyroid function will follow along on improved adrenal function.

    I’m afraid I have to disagree with this — you certainly can’t fix your thyroid malfunction until after you’ve fixed your adrenals, but fixing your adrenals will only address adrenal problems, and if your thyroid is not to badly worn down, it may be able to heal itself — but if your thyroid is shot, fixing your adrenals won’t fix your thyroid.

    The usual progression is: fix your adrenals, fix your thyroid, then fix your sex hormones. You can’t get the best response by trying to fix your sex hormones with a busted thyroid, and if your adrenals are worn out, fixing your thyroid won’t work, or won’t stick.

    Elenor wrote on July 16th, 2010
  33. …so how does one fix their adrenals?

    Kristina wrote on July 16th, 2010
    • Kristina, you need to have a saliva cortisol test done which will show adrenal rhythm (4 samples collected during the day) and if cortisol levelas are low or high. Check out the yahoo adrenal support group and STTM website for tons of great info.

      teri fout wrote on July 17th, 2010
    • One goes and reads up the in-depth and experientially based information on Stop the Thyroid Madness.

      Elenor wrote on July 17th, 2010
  34. Let me just add: before I discovered the Stop the Thyroid Madness site, I had always attributed my various “ills” to my age and my sedentary lifestyle. I would awaken feeling as if some guy had taken a bat to my “kidneys” (the adrenals sit directly on top of the kidneys). My neck would be stiff, my hair and skin were dry, the soles of my feet hurt,I often had some carpal tunnel pains. My morning mug of coffee would “unstiffen” me (turns out coffee whacks the adrenals to get them to perform — which isn’t a good thing, when they’re massively fatigued!).

    I began treating my adrenals (first with OTC pills (Isocort), then prescription pills (hydrocortisone, at replacement levels, not treatment levels!) once I finally found a doctor who was willing to prescribe what I asked for; along with the more ‘un-medical’ food and nutrient suggestions at STTM, such as sea salt which I used and licorice which I did not because of its potential blood pressure detriment).

    The results were amazing — my “old age ills” went away! No more stiff neck! The guy with the bat left the house! My hair actually softened!(In fact, I could tell when I needed to raise my dose because my neck would start to be stiff again, or my “kidneys” would be sore on arising.)

    After I started supporting my adrenals (the idea being to replace their actions with supplementation, so they can sleep and heal — and they have), I began treating my thyroid as well. Amazing! I have all my long life discounted “overweight is related to thyroid problems” “excuse” — but it turns out, that is exactly the case! (My doc even said: you can be exercising and eating exactly right, and if your thyroid is screwed up, you won’t lose an ounce!)

    (And, just a note in passing: I can tell when I need to adjust my thyroid dosing because my carpal tunnel returns. When the company that makes Armour desiccated thyroid changed their mfg process (and Armour became not just worthless for many people but detrimental, I switched to Erfa — the Canadian version, which still works for me), my first clue was that my carpal tunnel came *roaring* back (along with the bat-guy and my stiff neck) — and when I went onto Erfa, it went away again!

    Elenor wrote on July 17th, 2010
  35. I was diagnosed with a mild case of Graves Disease, followed by Hypothyroid, and put on thyroid meds 25 years ago (.025). My dose has been the same for about 15 years. I’ve never experienced any typical symptoms, such as fatigue, weight gain, depression. I feel no different when I take the meds or not. My TSH numbers are “normal” when I’m medicated. Should I keep taking the daily pill?

    Jeff wrote on July 18th, 2010
  36. Jeff without testing you cannot possibly know! Which meds are you on? As I wrote above — the TSH test is pretty much useless for diagnosing thyroid problems.

    Please check out “What We’ve Learned” on the Stop the Thyroid Madness site — it will give you some ideas to investigate to see if you can get off the pills.

    Elenor wrote on July 19th, 2010

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