Thyroid meds are some of the most prescribed drugs/meds/supplements out there.
Yet, the success rate is mediocre at best. Symptoms are not being resolved as expected and things might even get worse.
That’s because wrong tests are done, inferior meds are prescribed (T4 only vs T4/T3 mix or NDT) and/or wrong doses are used.
When it comes to tests, TSH is a horrible marker. It can vary a lot and can be artificially increased or decreased. The pituitary has different transporters for T4 and T3 compared to other tissue in the body, so if blood T4 and T3 are adequate, thyroid hormone production slows down. But this means nothing when it comes to tissue thyroid hormone levels. And that’s because tissue uptake of thyroid hormones is energy-dependent.
Even total and free T4 and T3 aren’t very good markers. More on that below.
Tissue thyroid hormones are what’s important, not blood levels.
That’s why you can have perfect bloods, but horrible symptoms. It’s very important to listen to your symptoms than trusting a blood test.
Here are a few symptoms people usually experience when they’re hypothyroid.
- Cold hands and feet and general cold intolerance
- Temps are below 37C or 98.6F
- Heart rate are below 70bpm
- Exaggerated stress response – heart rate speeds up like crazy, shaking, twitching, sweating, inner tension, etc.
- Hair loss
- Losing the outer part of eyebrow
- Feeling sluggish and being fatigued all the time. Can even experience chronic fatigue syndrome (CFS).
- Cognitive problems, such as depression, anxiety, slow cognition, little cognitive flexibility, not being open-minded, ridgit, etc.
- Fat gain
- Metabolic syndrome
- Bipolar depession
- Neurodegenerative disease (neurogenesis is energy dependent)
- Rapid aging
- Chronic infection
- Cardiovascular disease
- Inflammation and chronic illness
- Elevated cholesterol and triglycerides
- Decreased libido
- Muscle aches, frequent cramps, weakness and even fibromyalgia
- Slow reflexes. Muscle tranction and relaxation is slow.
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Aspirin is one of my favorite go-to supplements.
Aspirin is anti-stress, anti-inflammatory, pro-metabolic and last but not least, pro-thyroid.
In this study, aspirin has been shown to increase the T3 to T4 ratio (R). It’s also been shown to resolve thyroiditis and excess thyroid hormone production. In hypothyroid individuals, aspirin/salsalate (a medication that belongs to the salicylate class) lowers TSH and stimulates the metabolic rate (R, R).
In hypothyroid patients, it is possible to completely restore the basal metabolic rate to normal levels with dosages of the order of 8 grams daily of aspirin in divided doses (R).
Aspirin has also been shown to inhibit the binding of T4 and T3 to thyroxine-binding globulin (TBG) and thyroxine-binding prealbumin (TBPA), therefore increasing free T4 and T3 (R). This can enhance T3 and T4 uptake into cells.
Also, as I’ll discuss later, free fatty acids and bilirubin inhibit T4 and T3 uptake into cells, and aspirin lowers both of those (R, R), thus enhancing uptake of T4 and T3 into cells. So if certain studies show that aspirin lowers T4 and T3, that doesn’t mean that aspirin, inhibits thyroid hormone production, but that it actually enhances the uptake. That’s also why TSH drops and the metabolic rate increases.
Now, some might worry about this anti-lipolytic effect of aspirin on fat loss, but aspirin can actually enhance fat loss.
“salsalate treatment reduced body weight, decreased concentrations of serum free fatty acids and total and HDL cholesterol and increased palmitate oxidation and incorporation in brown adipose tissue.” (R)
The stimulation of the metabolic rate by aspirin, especially in brown adipose tissue, will promote fat loss.
If you’re concerned with the possible “side effects” of aspirin, check out these articles.
#2 Black cumin
Another good supplement with tonnes of health benefits is black cumin/Nigella sativa.
Just 2g of Nigella sativa seed powder can significantly lower BMI, IL-23 levels, TSH and anti-thyroid peroxidase (anti-TPO), while increasing serum T3 in 8 weeks (R).
If you want to minimize your PUFA intake, then a Nigella sativa extract will work great, such as this one.
Read more here on the benefits of Nigella sativa:
Ashwagandha has been used for 1000s of years for all kinds of conditions and diseases.
One study found that it could be helpful for increasing thyroid hormones and preventing hypothyroid symptoms.
“The treatment with ashwagandha for 4 and 8 weeks resulted in significant increase in serum T3 levels from baseline values by 18.6% ( p = 0.0121) and 41.5% ( p < 0.0001), respectively.
The treatment with ashwagandha produced a significant time effect on serum T4 levels [F (2, 23) = 21.803, p < 0.001, Zp2 = 0.655], which resulted in significant increase in serum T4 levels from baseline values by 9.3% ( p = 0.0027) and 19.6% ( p < 0.0001) at fourth and eighth weeks, respectively.” (R)
They used the KSM-66 extract in the above study, but I’m sure a full spectrum extract will have the same effects.
Gugulipid has been used for nearly 3000 years in Ayurvedic medicine, mainly as a treatment for arthritis. Herbal practitioners currently use guggulipid therapy in conditions as diverse as rheumatism, coronary artery disease, arthritis, hyperlipidemia, acne, and obesity (R).
Has pro-thyroid effects, by increasing iodine-uptake by the thyroid and enhancing activities of thyroid peroxidase and protease as well as oxygen consumption by isolated slices of liver and biceps muscle and enhances T4 to T3 conversion (R, R, R).
Finally, it’s an antagonist to the cortisol, aldosterone and androgen receptors and an agonist to the progesterone receptor, and also to the estrogen receptor also (however, the potency was very low (EC50 > 5000 nM)) (R).
So it seems like a really good supplement, but it has potential anti-androgenic and estrogenic effects, but we don’t know the full implications, since it’s also a cortisol antagonist and progesterone agonist. At the end of the day, what really matters is the cortisol to testosterone and the estrogen to progesterone ratio.
More studies are needed for sure.
Severely low serum magnesium levels are associated with an increased rate of TGAb positivity, Hashimoto thyroiditis, and hypothyroidism (R).
Iodine is used for the synthesis of thyroid hormones. There is a lot of controversy about whether it’s good or not and should be supplemented or not. There is evidence that it can make hypothyroidism worse and even contribute to an increase in antibodies and even thyroid nodules.
The following study (More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis) looked at the thyroid status of people living in different areas with different iodine intake. The Rongxing area had higher iodine intake compared to the Chengshan area,
“The prevalence of subclinical hypothyroidism was significantly higher for subjects who live in Rongxing than those who live in Chengshan (5.03 vs 1.99%, P<0.001). The prevalence of positive anti-thyroid peroxidase antibody (TPOAb) and positive anti-thyroglobulin antibody (TgAb) was significantly higher for subjects in Rongxing than those in Chengshan (TPOAb: 10.64 vs 8.4%, P=0.02; TgAb: 10.27 vs 7.93%, P=0.01). The increase in thyroid antibodies was most pronounced in the high concentrations of TPOAb (TPOAb: ≥500 IU/ml) and low concentrations of TgAb (TgAb: 40-99 IU/ml) in Rongxing.” (R)
The following 5 years study looked at the correlation between iodine intake and hypothyroidism or autoimmune thyroiditis.
“We conducted a 5-year follow-up study (from 1999 to 2004), and our data showed that among three communities in China with an MUI of 84 μg/l (a mildly deficient iodine intake area), 243 μg/l (a more than adequate iodine intake area), and 651 μg/l (an excessive iodine intake area), the incidence of either hypothyroidism or autoimmune thyroiditis increased with the increased intake levels (16, 17).” (R)
And lastly, another study looked at different levels of iodine intake (via fortification) and found that higher iodine intake was associated with a higher prevalence of hypothyroidism, subclinical hypothyroidism, thyroid nodules, positive thyroid antibodies, hyperthyroidism and Graves’ disease
“The prevalence of clinical hypothyroidism, subclinical hypothyroidism, and positive thyroid antibodies was significantly higher in MTAII cities than it was in AII cities. Moreover, the prevalence of clinical hyperthyroidism (1.1% vs. 0.8%, p = 0.033) and Graves’ disease (0.8% vs. 0.5%, p = 0.019) also significantly increased in MTAII cities. Compared with a five-year prospective study conducted in 1999, the prevalence of goiter significantly decreased (2.9% vs. 5.02%, p = 0.001), but there was a significant increase in thyroid nodules (12.8% vs. 2.78%, p = 0.001). The prevalence of subclinical hypothyroidism (16.7% vs. 3.22%), positive TPOAb (11.5% vs. 9.81%), and positive TgAb (12.6% vs. 9.09%) significantly increased, while no changes were seen in clinical hyperthyroidism, subclinical hyperthyroidism, or Graves’ disease. A total of 15,008 adult subjects from 10 cities in eastern and central China were investigated. adequate iodine intake (AII), and four cities as regions with more than adequate iodine intake (MTAII).” (R)
So how can iodine be bad if it’s essential?
The following study discusses three reasons:
“Totally, three mechanisms (47) have been assumed for the development of iodine-induced autoimmune thyroiditis. First, iodine intake increases the immunogenicity of thyroglobulin (Tg), thereby precipitating an autoimmune process at both the T- and B-cell level (48, 49, 50). Secondly, iodine has a toxic effect on thyroid cells (51, 52, 53). Thirdly, iodine directly stimulates immune and immunity-related cells (54, 55, 56). In Japan, the incidence of autoimmune thyroiditis is higher in areas with high dietary iodine intake (milligrams of iodine intake per day) than in areas with normal dietary iodine intake (4, 5).” (R)
So in total, we do need iodine, but supplementing unnecessary high amounts might come with side effects. Keep in mind not everyone gets side effects and some people do get benefits from supplementing it.
If you want to cover your basis, just supplement some kelp for 250-300mcg of iodine daily or eat seafood on a regular basis.
Vitamin B6 & L-dopa
Vitamin B6 is very abundant in milk, meat and organ meat.
Vitamin D and B12
This study found that vitamin B12 and vitamin D deficiency were associated with autoimmune hypothyroidism, and that there was a negative correlation between vit B12 and vit D levels and anti-TPO antibodies in these patients (R).
Vitamin D has also been shown to decrease TSH levels which is thought to be the result of an increase in thyroid hormone levels (that is the result of the stimulatory effect of vitamin D on thyrocytes) (R).
The thyroid gland has the highest concentration of selenium compared to other organs and many studies have observed selenium deficiency among patients with benign thyroid diseases (R).
Selenium is important for the functioning of many enzymes (selenoproteins) involved in the synthesis and metabolism of thyroid hormones and protection against oxidative damage (such as iodothyronine deiodinases, thioredoxin reductases and glutathione peroxidases).
Shellfish, beef/lamb kidney, beef/lamb/chicken liver are great sources of selenium.
Zinc is extremely important for proper thyroid function.
- involved in the synthesis of TSH (since it participates in the synthesis of TRH (as part of zinc-dependent enzyme carboxypeptidase that converts pre-TRH to pro-TRH))
- involved in the synthesis of thyroid hormones (as a cofactor of deiodinase 1 and deiodinase 2
- part of thyroid transcription factor 2 (zinc-finger protein) that is involved in the transcription of Tg and TPO genes)
- important for the proper functioning of T3 because T3 nuclear receptors contain zinc ions
Zinc supplementation has been shown to increase T3 (R).
Oysters, meat, organ meat and dairy are the best sources of zinc.
Although it’s bad in excess, we do need some for proper function.
Iron is involved in the synthesis of thyroid hormones, and its deficiency can alter thyroid hormone levels in several ways. Iron deficiency:
- can reduce TPO activity
- can increase rT3 deiodination, leading to thyroid hormone metabolism by inactivating pathway
- can lead to inefficient erythropoiesis, consequently causing a decrease in oxygen transport to tissues. Oxygen is crucial for various enzymatic reactions (including thyroid hormone synthesis)
- can result in low T4 and T3 levels (R)
Too much iron on the other hand can contribute to fatty liver, high cholesterol and triglycerides, insulin resistance, metabolic syndrome, low-grade inflammation, infections, aging etc.
Copper is very important for overall energy production in the cell and can help to increase T4 and T3. A few studies in euthyroid individuals have observed a positive correlation between copper levels and T4 (R, R) and tT3 levels (R).
Also, copper is used by superoxide dismutase, which lower excess superoxide free radical, thus protecting the thyroid against oxidative stress (R).
Bright light can have a lot of health benefits, a few includes lowers stress hormones and improving thyroid hormone production.
This study found that in winter, bright light exposure was associated with a significantly greater reduction in TSH and anger, a significantly greater increase in free T3 and a significantly smaller increase in depressive symptoms when compared with dim light. (R)
Bright light has also been shown to decrease rT3, which means that thyroid hormone uptake into the cells is increased (R).
If you’re prone to getting the blues during winter or “bad weather” days, then exposing yourself to bright light for 10min or more can do wonders for you.
Get yourself a 150W< flood light and bask under that for 10-60min first thing in the morning and also when you start to feel down.
Celery is frequently advertised for body recomp, and interestingly, it seems to work for that. There are two case reports of people becoming hyperthyroid and even losing a significant amount of weight (26kg in 78 days) due to it (R, R). Doses ranged between 4g of dried celery leaves or 8g extract. I’d stick to the lower dose, like 1-2g, see how you feel after 2 weeks or so before bumping up the dose.
#8 Manage your stress
Stress has harmful effects on almost every aspect of your body and well-being.
One of the reasons for the latter is because stress inhibits mitochondrial function and lowers ATP production and the transporter for T4 is much more energy-dependent (it requires more energy) than the transporter for T3.
Interestingly, when there is reduced transport of T4 or T3 into the cells, the serum T4 and
T3 levels increase (less is transported out of the blood) even though the production of
T4 and T3 are diminished. The reduced uptake into the cell will tend to increase blood levels, making the serum T4 and T3 remain normal or high-normal giving a false impression that someone is not hypothyroid (R).
Isn’t that crazy?
Arem et al. found that significant physiological stress was associated with dramatically reduced
tissue levels of T4 and T3 (up to 79%) without a corresponding increase in TSH (R). So stress might actually make you seem hyperthyroid, based on suppressed TSH and high T4 and T3.
“Substances produced by physiologic stress or calorie reduction (e.g., 3-carboxy4-methyl-5-propyl-2-furan propanoic acid (CMPF; is a metabolite of furan fatty acid and is increased in patients consuming fish or fish oil), indoxyl sulfate (produced by certain gut bacteria), bilirubin (when heme oxygenase is activated and heme is broken down in the body) and fatty acids (through lipolysis)), have been shown to reduce the cellular uptake of T4 by up to 42%, while having no effect on T4 or T3 uptake into the pituitary” (R)
So the whole point here is to not stress, or at least, manage your stress adequately.
#9 Fix your gut
Indoxyl sulfate (IS) is produced from tryptophan in the gut by various gut bacteria and is a product of intestinal putrefaction of dietary proteins. Dietary tryptophan that reaches the colon is converted to indole by resident microbes and absorbed into the systemic circulation. Indole is further metabolized by the liver to form indoxyl sulfate, which is then cleared by the kidneys through tubular secretion as described above.
IS has been shown to inhibit the active uptake of thyroxine (T4) into liver cells, but not pituitary cells (R). So with an excess of IS, you can have normal TSH, but have all the hypothyroid symptoms.
A lot of people that have severe hypothyroid symptoms also have digestive problems. If you have used thyroid and digestive aids before and it did not resolve your gut problems, do a stool test (I prefer Biomesight) to see what’s going on, so that the gut can be addressed directly.
I also wrote an article on how the gut influences thyroid function and hormone production.
#10 Avoid calorie deficit deficit
A calorie deficit is also a stressor. When you reduce food availability, the body has to break itself down to provide the missing fuel. This puts the body under stress and lowers thyroid hormone production and also uptake.
In a highly controlled study, Brownell et al. found that after repeated cycles of dieting, weight loss
occurred at half the rate and weight gain occurred at three times the rate compared to controls with
the same calorie intake (R). If you Jojo diet for too long, fat loss can become very hard.
“Furthermore, severe caloric restriction and weight cycling is shown to be associated with reduced cellular T4 uptake of 25%–50%. 3, 48, 77, 79–81 Therefore, successful weight loss is doomed to failure unless the reduced intracellular thyroid levels are addressed, but, as stated previously, this reduced cellular thyroid level is generally not detected by standard laboratory testing.” (R)
“In a study published in the American Journal of Physiology-Endocrinology and Metabolism, Van
der Heyden et al. studied the effect of calorie restriction (dieting) on the transport of T4 and T3
into the cell.48 They found that obese individuals in the processes of dieting exhibited a 50% reduction of T4 into the cell and a 25% reduction of T3 into the cell” (R).
I’m not trying to say you should always be bulking, but there are right and bad ways of going about losing weight. The best way to lose weight is to eat a diet that stabilizes blood sugar, is satiating and gives you lots of energy to move around and burn calories willingly (not forced exercise).
#11 Avoid these chemicals or drugs
Many synthetic compounds inhibit thyroid hormone production, conversion and/or receptor. So despite having enough thyroid hormones, you can still have hypothyroid symptoms due to being loaded with endocrine-disrupting chemicals (EDCs) (R).
A few of these chemicals include:
- Polychlorinated biphenyls (PCBs) and polybrominated biphenyls (PBBs) which are found in electrical insulating fluids and in carbonless copy paper, inks, paints and other industrial and consumer products (R).
- BPA, found in most plastics (R)
- Phthalates, found most abundantly in clear and soft plastics (R)
- Perchlorate is a chemical substance used in the production of propellants, pyrotechnics, airbags and fertilizers and is approved as a food contact substance (therefore, it can be released into various foods, milk and water) (R)
- Perfluoroalkyl substances (PFASs), which are used as surfactants in products such as textiles, paints, food packaging, cookware and cosmetics (R).
- Pesticides (R)
- Arsenic (R)
- Cadmium (R)
- Lead (R)
- Mercury (R)
- Benzodiazepine medications such as diazepam (Valium®), lorazapam (Atavan®), and alprazolam (Xanax®) (R)
#12 Inhibitory foods
Certain foods can have an inhibitory effect on thyroid hormone production. Usually, these foods are only a problem on a low iodine diet or in infants/children.
Some of these foods include:
- Millet (R)
- Cassava (R)
- Bamboo shoots (R)
- Seaweed – “Studies in euthyroid humans have observed an increase in TSH levels after seaweed consumption [142,143,144] (Table 1). However, Noahsen et al., observed a transient 150% increase in TSH levels in euthyroid individuals after consumption of seaweed (while fT4 levels remained unchanged) that returned to normal within three days .” (R)
- Soy. In humans, infants fed with soy formula have been shown to develop goiter. However, in post-menopausal women soy intake did not affect thyroid function. (R)
It’s sometimes/often best to go by symptoms instead of boost tests, because as mentioned above, you can have normal levels, but have most of the hypothyroid symptoms.
A relatively reliable way of seeing tissue thyroid hormones is to look at the T3 to rT3 ratio, 2 markers doctors almost never test for or look at or know how to interpret.
“assessing the free T3/reverse T3 ratio can aid in a proper diagnosis, with a free T3/reverse T3 ratio of less than 0.2 being a marker for tissue hypothyroidism (when the free T3 is expressed in pg/mL (2.3–4.2 pg/mL) and the reverse T3 is expressed in ng/dL (8–25 ng/dL))” (R)