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 have been hyo/hashis/low testosterone for 4 years now. Despite being on 3.5 grains my Antis refuse to drop….


    park wrote on August 16th, 2010
  2. I was found to have a TSH of 94 in February, 2010; 23 in April/May, 2010; 16.5 in August, 2010. I definitely have the antibodies against my thyroid… but my endo told me it doesn’t matter what the level is after it’s elevated once – because it can always become elevated again… if you create the antibody against your tissue, then your tissue can always be targeted… so improvements in that value mean nothing! Memory cells create the antibody with no notice to the body. Anyway, I’m embarking on a water fast of several days with hopes to improve my thyroid. I feel normal… run 2.5 hours at times, have normal energy, clarity of mind, and only slightly moody. I am behind Mark’s theory that maybe the abnormality could be with the establishment rather than with the masses… but anyway, I’m also with him on following symptoms…

    Caroline Smith wrote on August 27th, 2010
  3. Well I read Dr Kharrazian’s book after starting the PB diet. I had felt better being gluten free but since 20% was allowed (80% primal), I felt like shit and became ill every month again (and back on antibiotics from my doctor).
    So I re-started the PB lifestyle but with 0% gluten this time and I feel wayyyyy better.
    I have most hypo symptoms but my lab tests are just below top limit (Dr Kharrazian explains that this result should normally alert a well informed doctor, well not mine). Obviously I belong to the 50% of people who fall through the test because their thyroid is still able to function. I’ve got a nice goiter though.

    The PB just looks like the perfect diet.

    Nossar wrote on November 28th, 2010
  4. I had hashimoto’s since high school…diagnosed as papillary thyroid cancer in 1999 – 6 months after birth of my only child. Had a total thyroidectomy and I-131 a year later…now on Synthroid .15 mg as a supressive dose (been 11 years now).

    Gained weight. Stubborn to lose no matter what activity level – until I started Intermittent Fasting. My question is – is there anything about IF that I should be concerned about or watching with an IF diet and synthroid/no thyroid of my own?


    Jenn wrote on January 17th, 2011
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    sonDeenna wrote on February 1st, 2011
  6. Hi there

    I went Primal just over 3 weeks ago and already my Cholestrol levels have lowered dramatically from 8 to 4.6, I am taking 75mg Eltroxin each day and am very excited about seeing how Primal and Crossfit training can alter my dosage.

    Thank you for all the daily tips.

    Tanya Cawley wrote on February 17th, 2011
  7. I have Graves Disease which my doc feels may have been triggered when my son died in 1986. All of the symptoms I was experiencing in the following years [which I now know are classic Graves symptoms] I attributed to grief (which, they also were).

    I spent 15 years asking docs to test my thyroid and being told it was fine, I just needed to eat less and exercise more (even tho I’d weighed between 112-115 my entire adult life; I weighed 135 lbs the night before my son was born!).

    I tried everything I knew, from the “sensible” to the crazy – nothing helped. Lose 2, gain 5 became a way of life.

    Finally I found an ENT doc who specialized in allergies … and who was hypothyroid himself. And who believed in symptoms more than numbers. On my first visit he spent an hour with me asking questions and examining me. Then he ordered 22 blood tests. When my thyroid became more under control, he sent me for a GTT – and found out I’m insulin resistant. He suggested an eating program that comes remarkably close to Primal … except that he allowed Ezekial bread and basmati rice. He wanted my diet to consist of 30% protein, 30% fat, and 60% carbs (of the veggie, like greens, kind).

    It’s been amazing. And now i’ve found Primal and am beginning to incorporate this into my life – it just makes so much sense! And I know that I feel better – more energy, better sleep, times when I actually forget to eat because I’m not hungry.

    I’m just beginning this leg of my journey … and it feels good.

    Journey wrote on October 20th, 2011
  8. How about having a normal thryoid (normal T4, TSH) but consistently low T3? Many studies seem to show that low-carb eating lowers T3, and if this is a peripheral effect (i.e. resulting in poor T4 to T3 conversion), could this explain why I gained weight on Atkins, and did not looes any while following PBP priciples either? Anyone have any insight or experiences?

    Lilian wrote on November 27th, 2011
  9. Synthroid is not “crap.” It is working great for me because my doctor is responsive to my symptoms, and also willing to push my TSH down to a lowish number in order for me to feel good. Synthroid may not work for everyone. But that does not mean that it is crap.

    I was on Armour and felt good in the mornings, cold as hell and tired at night. I didn’t feel even. I don’t think Armour is crap, though. I just didn’t like it.

    jenni wrote on January 16th, 2012
  10. my thyroid became dysfunctional after having 2 tonsillectomy operations at the age of 14. i had an abscess which was very persistent and they needed to remove one tonsil twice and left a small cave in my throat.
    It makes me angry because nobody diagnosed it yet i had all of the symptoms. i was never hungry, i ate practically nothing. I gained weight and went from a uk size 8 to 18 in just a few months. i lost my eyebrow hair. my face was white and puffy. worst of all was the mental health effects. i was so depressed without explanation. i visited my GP and he just told me i was fat. So i took an overdose because i didn’t know what else to do. I was 16 by this point and i just didn’t have any solutions or explanations as to why i felt so bad.
    Since then my weight has been up and down between size 10 and size 14. I’m guessing the trauma to the thyroid must have corrected itself somehow because my eyebrow hair has grown back and i feel almost normal most of the time.
    Hypothyroidism is the worst thing i have ever experienced.

    Anna wrote on April 25th, 2012
  11. Being hypothyroid is not a good thing- I have Hashimotos and hypothyroid and can tell you I lost many years of my life to depression and fatigue. The only thing I remember about my entire marriage of about 10 years is being depressed, resentful of my spouse, and greatly fatigued and not knowing why. It’s not until I got on Armour this last summer because my thyroid levels had finally dropped too low, and went gluten free that I have been starting to get my life and sanity back. Mark needs to go hypo for a few months to realize this. It is not a good thing at all.

    RM wrote on May 3rd, 2012
  12. I agree with Jenny. Synthroid saved my hashimoto’d life! T3/t4 nearly killed me. I am very fit, 35yo and combo meds put me into atrial fibrillation! Scary! I have done very, very well on Synthroid. One mans trash another’s treasure! ;)

    Kris wrote on August 28th, 2013
  13. I had a TSH of 5.5 and thought I’d ditch my tablets and go primal.the result? my front door was kicked in by concerned neighbours who found me unconscious in my bed.i have three children under 5 and I am a single mother.they were home when this happened. ..and I almost lost them to CPA for being non compliant and risking my own and my kids’ lives.

    Leela wrote on October 28th, 2013
  14. Maybe this will help someone else: a few years back had been tested as others mentioned, they told me “no problem.” Yet worsening symptoms and related problems that seemed to point to hypothyroidism.

    Looked into an Ayurvedic remedy, guggul, recommended for thyroid imbalance. Just a few days after I started taking it I woke up one morning feeling “normal,” as in — really good. And continued well-being since then.

    You can take guggul by itself or in formulas, make sure you get a very good-quality brand. I like Himalaya Herbal Healthcare (reasonably priced on iherb).

    Brophie wrote on November 3rd, 2013
  15. Referred to this post when I contacted Mark’s Daily Apple for autoimmune meal plans.
    It’s an old post but in case anyone else is still looking for help with Hashimotos, I would not recommend STTM or Datis Kharrazian. (he’s a chiro not a MD and just wants to sells supplements).
    Stay away from iodine, check for parasites, candida, leaky gut and hormone imbalance. T4 only meds are great IF your body will convert to T3, if not use Armour.
    Try Mickey Trescott’s AIP. NO to IF & low carb (ketosis) and intense exercise.

    Personally I find get the hormones balanced the most difficult, too much mis-information out there and too few trained MD’s.

    apelila wrote on February 17th, 2014

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