You are sitting there in front of your doctor all wide-eyed and hopeful that this time there will be an answer to your ongoing issues. This time there will be a reason you are adding symptoms and diseases instead of improving. This time there will be a clear-cut way forward out of the murkiness of thyroid disease. It's not much to ask, is it?
1. Excess stress
This is one of the biggest drivers of how you feel with thyroid disease. If you are experiencing stress in any way at all - physical, mental or emotional, then that will result in your active thyroid hormone being converted into Reverse T3 and being shunned away by the thyroid receptors.
This can look like low T3 so the doctor goes ahead and gives you T3 separately, which may in fact make you feel better, but does not change the underlying problem and the cortisol cascade causing major issues with your adrenal function because they are constantly in flight or flight mode. Which makes you feel horrible anyway.
If you are really struggling with stress you could look at an adrenal supplement such as Adrenal Cortex which I have taken myself many times over the years as life got a bit out of control.
Thyroid disease is an inflammatory disease. It causes inflammation and is made worse by inflammation. Kind of a two steps forward one step back kind of thing. However, if you are really vigilant about reducing your inflammation and keeping your immune system calm by not consuming foods that cause flare-ups or covering your body with too many chemicals then it is possible to keep inflammation to a minimum. It's the inflammation that causes those "thyroid crappy days" where you just feel like you can't do it.
So the doctor may tell you your labs are fine, but likely has not run any inflammation markers to see what is happening there. You of course could go ahead and have him run a CRP or ESR to check your inflammation, but at the end of the day, it is still up to you to do something about lowering it, such as improve your diet, take anti-inflammatory herbs such as turmeric or Boswellia (which I particularly like for thyroid women). You can find good quality options on iHerb which ships internationally. I particularly like the Thorne Research products that you can find there. Make sure your turmeric is always accompanied by Black Pepper to make it work the way it should.
Low iron is extremely common in thyroid patients and has a major impact on your thyroid health. You may be feeling horrible because of fatigue due to low iron instead of simply a non-functioning thyroid.
You need iron to help convert protein into the amino acid tyrosine. Tyrosine is the "T" in "T3" and T4" so a really important component and one that will wreak havoc, not just on fatigue but particularly on your mental health as tyrosine is a precursor to tryptophan our feel-good hormone.
Foods high in Tyrosine include chicken, turkey, fish, peanuts (perhaps why so many of us crave peanut butter), almonds, avocados, bananas, lima beans, pumpkin seeds and sesame seeds.
Polyunsaturated Fatty Acids (PUFAs) are vegetable oils and they have the ability to hijack your thyroid hormones' transport carrier leaving them stranded in your bloodstream instead of on their way to your cell receptors. This may then show up as high T3 (assuming you are converting correctly) when it is simply a case of not enough protein transport carriers or more likely, plenty of transport but too many PUFAs that can get on board first.
Vegetable oils are also filled to the brim with Omega 6 Fatty Acids. In high amounts Omega 6s are inflammatory and sadly as a society, we are getting around 15 times more Omega 6 than Omega 3 and we need only the same amount, meaning a ratio of 1:1.
These oils are hidden EVERYWHERE! You will even find them in some of your spice mixes that I'm sure you assumed only had spices in them right?! If you are consuming any kind of processed food at all, meaning anything that has been pre-prepared you can assume contain some kind of vegetable oil.
Selenium is a vital mineral that appears in your thyroid pathway many times. It helps make DNA and protects us against cell damage. It is also an antioxidant that helps remove free radicals which our body naturally produces when making thyroid hormone.
Selenium is vital if you are under physical, mental or emotional stress as it has the ability to revert Reverse T3 (RT3) back into Active T3 (the one we need to feel good) which is a good thing! RT3 is our indicator of high-stress levels.
You don't have to make it too difficult either. If you like Brazil Nuts, then keeping them on the Fridge door and munching on two every evening while deciding what you are making for dinner will cover you! No supplements are required and those tasty little nuts come with the added benefit of iron, magnesium, manganese, calcium, zinc, Vitamins B1, B2, B6, Folate and Vitamin E! So good!
In a very high portion of thyroid cases, a leaky gut is present, which not only means you have things going into your bloodstream that shouldn't be there, but you will also struggle to absorb the vitamins and minerals you need at each stage of your pathway.
From a Thyroid Pathway perspective, your gut is responsible for converting about 20% of your inactive thyroid hormone into an active hormone. So if your gut is not healthy, you may have plenty of T4 floating around in your blood but not enough T3, which is also why you need more than a TSH test, you need a full Thyroid Panel to understand what is going on.
Your biggest friend for gut health is hands down FIBRE. Fruits, vegetables, nuts, seeds & legumes are our fibre friends.
A great book to read on this topic is Fibre Fuelled by Dr B. It is a real eye-opener and helps you understand the relationship our gut microbiome has with food and specifically fibre. He also has a great recipe book.
However, to really make it simple, you should just aim for as many different varieties and colours of fruit and veg as possible. We did a challenge in Thyroid School once of eating a minimum of 100 different plant foods in 30 days. It was so much fun and many of the participants found themselves (including myself) trying many new plants we had never considered eating before!
Having a fatty liver (which is alarmingly common these days, even in children) is a major player when it comes to interrupting the conversion of the Inactive T4 hormone into the active T3 hormone. Any liver issue at all can slow down this process and since the liver is responsible for 70% of this conversion it often presents itself as needing a really high amount of thyroxine to get a normal TSH. For 20 years I was on 250mcg, and it was not until I addressed my liver in a very specific way that I was able to start bringing down my medication amount.
Fun fact... (not really fun, but def a fact...) any synthetic medication is hard on the liver and will cause its degradation the longer you take it. Yes, even the ones we need like thyroid hormone replacement become toxic to our liver over a long time of taking it. That's probably why when you stop it or forget it for a few days you feel quite well... until you don't!
Unfortunately, an extremely large sector of the population now has Fatty Liver Disease, which seems rather benign, however, it follows the same path as an alcoholic's liver (that's why its full name is Non-Alcoholic Fatty Liver Disease or NAFLD) where you end up in cirrhosis with the need for a liver transplant in the worst-case scenario. Our children are even developing this! To be honest I'm really not sure that many people understand how dangerous this issue is.
Leading on from the fatty liver, if you are a regular consumer of pain killers (not judging, as many thyroid patients are in chronic pain daily), these will contribute to your liver struggling to convert your inactive T4 hormone into active T3 hormone. There is a very particular reason here though so buckle up it's about to get a bit sciency...
The liver has 6 pathways of its own, kind of like a recycling system, where different chemicals are processed and different nutrients are recycled and turned into what we need. The problem is that painkillers and thyroid hormones actually have to go down the same pathway, known as the sulfation pathway.
Now, add to that piece of information that sulfation comes from sulphur which is the cruciferous family that you have been told since you were diagnosed you shouldn't touch that your body needs for that particular pathway to flow smoothly and you can see that there is a struggle right? However, as we continue to learn, and science finds out new things, I can safely tell you that if you cook your cruciferous veg then you are removing the goitrogens so will not cause a problem with the thyroid but will help the liver out too. So there are no excuses now for not eating your Brussels Sprouts!
A lack of Vitamin A can actually give a false high TSH reading in blood tests.
While that may not seem like a problem, for thyroid patients it actually is, because there is an issue with converting Beta Carotene into Vitamin A for a start.
Since many doctors are only looking at the TSH levels to determine your thyroid health you can see how this could be problematic for appropriate treatment and dosage decisions.
Deficiency symptoms of Vitamin A include: trouble seeing in low light, diabetes, ear infections, regular nose and throat infections, dry skin, infertility, dry eyes, delayed healing, gallbladder dysfunction, sinusitis, poor sense of smell and taste, acne and boils.
This one kind of goes with the inflammation but can be tricky, ongoing and hard to beat if you can't locate the cause of the high antibodies. And yes, there will be one... you just haven't found it yet!
Antibodies (no matter if they are for Graves or Hashimoto's) come out to attack when it thinks something is in the thyroid that shouldn't be there. Often the thyroid tissue becomes collateral damage in the hunt for the pathogens.
Whilst usually this trigger is a food item or environmental allergen there is a growing body of evidence pointing towards stress as an instigator of antibodies. In fact, one study found that stress can bring on antibodies in an individual who does not have that disease. So we end our list with a similar message as the first one. If you have been struggling to lower your antibodies and are doing all the things, then stress is your final frontier!
Here is the bottom line when it comes to our blood tests. They only test what is in the blood, not what gets into our cells, and that is when we feel better. Knowing how your Thyroid Pathway works is your first step in not getting stressed out about what your doctor does or doesn't know about you. Instead, it empowers you to take control of your own health and outcomes.