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. Women often have thyroid problems after after pregnancy. I certainly have. Being only “mildly hypothyroid” according to my numbers – I still really didn’t feel like myself. I had weight gain (40pnds), poor concentration, sleep and energy difficulties and depression and no sex drive at all. The worse part was not knowing what was happening and why I felt so different in every aspect of my life. And I was so busy with a baby that I suffered too long before I got diagnosed. I’ve only seen improvement in all of those realms with conventional pharmaceudical treatment. Just saying, it doesn’t have to be Armour or “natural” to work for you. Also, if you feel good and your numbers are fine – think twice, or be careful about getting off of your medication. I stay on top of my numbers, and I’m interested to see how eating close to primal will change them. So far I’m loosing weight and feeling fantastic. And I really like the recipes and advice on this blog. Thanks so much!

    tbird wrote on July 19th, 2010
  2. I had hypothyroidism and it was ruining my life. I was sleeping all the time, always depressed, overweight despite a “healthy CW diet”, fatigued, and generally uncomfortable. it is what prompted me to switch to the primal diet. And all those symptoms went away, and now I am one of the healthiest and most energetic people I know. I have not had my numbers checked again, but I can tell you at this point those numbers don’t mean anything. my body speaks for itself. i dont think people with hypothryoidism need medication, i think they need to go primal.

    Mar wrote on July 19th, 2010
    • That’s wonderful that primal alone helped you. It doesn’t help everyone. Thyroid disorders left untreated can eventually kill.

      angela wrote on July 20th, 2010
  3. I agree with some of the others who say that living longer isn’t worth it if I have to be hypo my whole life, even mildly so. I feel best when my numbers are heading toward hyper. Otherwise I’m fatigued, and I can’t maintain a normal weight, even with 10+ workout sessions a week (mixed cardio and weights.) I’m lucky to have a dr. who diagnosed me with Free T’s and symptoms; had I listened to the 2 drs. who told me I was “euthroid,” I might still be in bed….

    I’m a fan of this blog and I link to it from my own; but this isn’t the first time it looks as if a post went out before all the correct research was done. The recent post on SIBO really missed the mark as well – it is not dysbiosis and yogurt isn’t always the answer. SIBO isn’t a compromise of gut flora, but usually related to a larger structural error.

    angela wrote on July 20th, 2010
  4. Being hypothyroid has made life very difficult for me for much of my life. Lab results for TSH were always within the norm and doctors never took into account my symptoms of fatigue, brain fog and more. Instead I was prescribed antidepressants and stimulants. I finally found a naturopath who is working with me to solve the problem. Recent lab results show low TSH, adequate T4 but very low T3. I have been taking armour thyroid but will add t3 to my regimen. I am also planning to have cortisol levels checked. A few months ago I ordered a number of thyroid books including Stop the Thyroid Madness and Why Do I Still have Thyroid Symptoms ( by Datis Kharrazian). These books have certainly provided me with knowledge and the hope that I will feel better soon. I recommend them. BTW, I have been primal for over a year and never consume grains.

    Gwen wrote on July 21st, 2010
  5. 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
  6. 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
  7. 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
  8. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
    • This is terrifying. Thank you for commenting. Clearly you were not just having some transient difficulty converting T4 to T3 due to stress (this is the only situation in which I can imagine the primal advice making any sense at all. I think it only comes up because people who are just sleep-deprived get TSH labs done, but they would never be considered hypothyroid back in the days of clinical diagnoses?? Or maybe the primal advice just makes no sense). Anyway, I hope you’ve stayed well!

      anon wrote on August 11th, 2016
      • I misspoke re. TSH; I meant “getting T3 (and T4 and reverse T3) tests done” leads to unnecessary diagnoses when there aren’t multiple clinical indicators or a high TSH. I don’t know if this is common, but a holistic physician took my husband down this path and prescribed a minuscule amount of compounded T3. He ended up going the “primal way” and abandoning this thyroid dose, because he wasn’t actually hypothyroid–he didn’t have an elevated TSH–and he had no thyroid condition. He did need stress reduction and sleep.

        I do have a thyroid condition, and it’s usually been my challenge to get adequate HRT. No endocrinologist has ever pushed thyroid meds on me. I still think undertreatment is more common than the overtreatment my husband experienced.

        anon wrote on August 11th, 2016
  18. 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
  19. 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
  20. I wish that I was never born because of my hypothyroidism. I was diagnosed at 19 because I had become very depressed and gained weight. I was prescribed Synthroid by the campus doctor, never told about alternatives like dessicated porcine thyroid. I never felt myself again –

    I had always been an excellent student, gaining entry to top 25 university in the U.S. But after my thyroid went awry, I found it difficult to focus and concentrate. My memory was not as sharp as it used to be, and my depression continued. Also, on top of all that, I started losing hair at age 21. By age 26, my hair thinned to such a point that I began wearing a wig. I had always been shy and self-conscious beforehand – now my self-esteem was shot. As a woman, I felt like damaged goods and unworthy of any good guy. Overweight, depressed and balding – Wow, what a prize!

    Now I’m 40, never married and have struggled career-wise. I’ve felt easily overwhelmed, disorganized and oftentimes clueless so I could not progress upward from entry-level. My family went through economic hardship during my last year of college so I had to work full-time to help out (not live at home to simply save money like other kids). I couldn’t go to grad school until just recently.

    In fact I did so to switch to teaching but am burdened now with so much paperwork that is particularly taxing for me. As a result I’m on probation and may lose my job because of my inability to focus and organize. I’m crying while I type this – I had graduated 2nd in my high school class, the first in my family to attend college, always the A student since 4th grade.

    I endured bullying and taunting from my working class peers so that I could get out of the neighborhood and make something of myself. But the joke was on me – weight gain and hair loss for a woman is the death knell, virtually ensuring spinsterhood. And my inability to focus and concentrate have stymied my professional aspirations.

    I’m a burden to my family – I wish that I was never born. I told my administrators about my thyroid condition, but they don’t care. The American Disabilities legislation covers thyroid disorders, but the school district HR dept doesn’t care. I can’t afford a lawyer to defend myself. If they don’t renew my contract, then I’m not just shut out from that school but the whole school district. Plus other schools will look at me askance for being non-renewed. And the salary pittance offered by private schools is not a living wage for a single woman (oftentimes married women with suitably employed spouses can subsist on those wages).

    I’m a new teacher, but they think that I’m just lazy because I’m well-spoken and write well (wow, imagine that – a public school teacher who can actually utilize proper diction and grad-school level vocabulary in everyday speech and emails!). They pooh-pooh the idea that my thyroid condition is serious because of the relative ubiquity of the disease.

    Compared to some other teachers, I’m uncommonly bright in certain areas so they think I should be able to handle all the demands placed on teachers – to stay up late at night as long as it takes to finish writing lesson plans (which by the way I can’t – I have to sleep 7-8 hours or I come down sick with sinus infections and the like), plan with other teachers during free period, calling all students’ parents and documenting calls/follow-up emails, filing paperwork, grading student work, recreating exams to align with Common Core objectives, create retake exams for each test and offer these to students who scored less than 85%, track test data results, differentiate according to student’s different learning styles & abilities, incorporate Higher Order Thinking Skills (HOTS) questions in guided practice, advocate in the outside community in order to achieve at least Proficient on teacher evaluation, submit detailed paperwork for unruly students in order to remove them from class in order to be able to teach students who want to learn, stay after school at least day every week for meetings or professional development, take continuing education courses to keep license current, fill out required district/school surveys, ensure students are serving lunch detention,… the list goes on.

    I haven’t finished, but what compounds the difficulty of this job is the behavior of many students – Imagine that you’re cursed out at least once a day and sometimes feel frightened that a full-grown male student will hit you. But if you call security too often to send these threatening students to In-School Suspension, you get penalized for not having good classroom management skills. The lack of respect from students, some parents, the state and the public in general is demoralizing.

    It’s my fault for being foolish enough to quixotically think that I can “make a difference.” I just have to realize that like Charly in “Flowers for Algernon” – mourn the loss of who you used to be.

    Hope wrote on April 13th, 2015
    • I know it has been a while since this comment was written, but this comment made me sad. I just wanted to say…Hope, I am sorry for what you have been through, and I hope you have found the help you needed.

      Nancy wrote on March 19th, 2016
  21. Old post, but I though it’d be worth weighing in since I’m very passionate about thyroid healthy.

    It honestly never sits right with me when a study says that (insert condition/behavior) increases lifespan. First of all, eating healthy, sleeping well, and pursuing a healthy lifestyle in general in and of itself cannot and will not increase lifespan-it will just protect you from disease and give you a better sense of well-being. I believe that the same thing applies here. To say that a slightly slowed metabolism “may” increase lifespan simply is not making sense to me. Say Person A has a slightly reduced metabolism whereas Person B’s metabolism is moderate, leaning towards neither hyperthyroid nor hypothyroid. Person A and B are both 30 years old. Person A walks outside one day and gets hit by a car and dies. Person A’s slightly low metabolism has not done anything to lengthen his life. It could not save him from the car. Person B, on the other hand, lives until his 70’s.

    ^ That is exactly what goes through my mind with all of the “lengthens lifespan” studies.

    And plus, I’m pretty sure people would rather live a life of good quality that is not jeopardized by an over nor under-active thyroid-whether it be the full blown illness or just a slight tendency towards them. What happened to “quality over quantity?”

    Just food for a thought..

    Deena wrote on November 24th, 2015

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