This is Part 2 of a two-part Your Thyroid Questions Answered series, wherein I answer a mix of situational and common thyroid health questions submitted by listeners with Graves’, Hashimoto’s, and other thyroid conditions. We cover topics like thyroid antibodies, lab interpretation, medication decisions, iodine, fatigue, hair loss, nodules, and lifestyle factors such as fasting and gut health. If you would prefer to listen to the interview you can access it by Clicking Here [1].
In this episode, I’m tackling your top thyroid questions. We’ll dive into topics like reducing thyroid nodules, understanding your TSH numbers, and managing autoimmune thyroid conditions like Hashimoto’s. From managing inflammation to figuring out if you can ever get off thyroid meds, I’ll give you real, actionable answers. Let’s get started.
What can I do to reduce thyroid nodules, which are causing my TSH numbers to be low?
There is an underlying cause of thyroid nodules. Unfortunately, most medical doctors don’t do anything to address the cause of the problem, not just with thyroid nodules, but with many other thyroid and autoimmune thyroid conditions.
Some of the common causes of thyroid nodules include insulin resistance, problems metabolizing estrogen, overall inflammation. I do have some other episodes on the podcast talking about thyroid nodules. You might want to do a search on my website, SaveMyThyroid.com, for thyroid nodules to find those episodes. I have solo episodes and some people I interview.
You definitely want to do things. If someone has blood sugar imbalances, you want to address that. If someone has problems with estrogen metabolism, which you could find out by doing a dried urine test like the DUTCH test, you would want to do things to support the metabolism of estrogen.
I won’t get into great detail here because I have separate episodes where I talk about more specifically things you can do. If you have problems with estrogen metabolism, I do have episodes where I focus more on that. Same thing with insulin resistance and type 2 diabetes.
There is also what’s called radiofrequency ablation, which is not radioactive iodine. Some people get the two confused. Radiofrequency ablation is using radiofrequency waves to shrink the nodules. The downside is you are not addressing the cause of the problem. It can also be expensive if insurance doesn’t cover it.
It is another way to save someone’s thyroid because when someone has especially larger nodules, suspicious nodules, many times, medical doctors will recommend thyroid removal/thyroid surgery. There are things you can do to shrink thyroid nodules.
Those of us who are euthyroid, but with thyroid eye disease (TED) and elevated TSI but normal TRAB, what supplements might be recommended to reduce inflammation?
This is a perfect example. Usually, if TSI is elevated, TRAB will be elevated. TSI is a little bit more specific when it comes to Graves’ and TED. If someone just has TRAB and is negative, you might want to consider testing TSI. And vice versa. If someone has negative TSI with hyperthyroidism and/or TED, you might want to look at testing TRAB.
Supplements. Selenium is important. Having healthy Vitamin D levels is important. Healthy omega-3 fatty acids. Supplementation could help with all of these.
When I say Vitamin D, you could try to get as much sun as you can, but you could also supplement with Vitamin D.
Same thing with omegas. Try to get as much as you can through fish, even though I can’t say I recommend eating fish every day because of the toxins and toxicants in fish. Eating it 2-3 times a week could give you a good amount of omegas. I can’t say I never eat fish, but I don’t eat it frequently. I rely more on omega-3 supplements in the form of fish oils.
There are other supplements. I actually have a TED bundle, which you can find out more about at TEDBundle.com. It does have selenium, and it has something called SMT BerbALA, which is a combination of berberine and alpha lipoic acid. The research shows that both of those can help with TED. I have had people take the TED Bundle, which has three supplements: selenium, SMT BerbALA, and SMT Immune, which is an immune supplement that helps with reducing inflammation and supporting the immune system.
That was the question: What supplements might be recommended to reduce inflammation? SMT Immune can help with reducing inflammation, but the selenium and alpha lipoic acid help reduce oxidative stress, which is a big factor in TED.
I believe that taking my thyroid meds for years, diagnosed hypothyroid, based on lab values, caused the atrophy of my thyroid that is seen on ultrasounds. What do I do now? My gland is supposedly gone. Now I am truly dependent on levothyroxine for my whole life. Do you have any experience in helping regrow the thyroid? How do I get off levothyroxine?
Good question. I unfortunately don’t have a great answer, meaning that I can’t say yes, I’ve had people in a similar situation follow this protocol to help grow back the thyroid. There are some situations where if someone has been on thyroid hormone replacement for a long time, and they have Hashimoto’s, which is causing damage to the thyroid gland, or in your case, maybe that’s not the case, it’s just the atrophy.
One thing you could look into is cold laser therapy. I have some episodes, one by Kirk Gair. You should find the episode on my website. That might help regain thyroid function.
If it’s atrophied that much, I don’t even know if there is hope with that. I’m not saying there is absolutely no hope. Maybe in the future, things like stem cells might help.
I wouldn’t say to give up. I would have realistic expectations. Might be worth speaking with a different practitioner. I am probably not the practitioner in this situation, but there are others who might be able to help potentially, like Dr. Kirk.
Tried a tiny bit of L-carnitine. I was wondering why it made me sleep the whole day. Just wondering what your thoughts are.
Interesting. I’ve had a lot of people take L-carnitine. Helps to support mitochondria, which usually does the opposite. It might help with energy. Helped with fatty acid oxidation.
It does block the entry. This is higher amounts, but you took a small amount. Higher amounts block the entry of thyroid hormone into the cell. I have not seen people go hypo on L-carnitine, but if it had that effect, it could make someone sleepy.
Otherwise, I don’t have a great explanation other than everybody is different. For example, I’ve had people take magnesium at night and have issues sleeping, whereas magnesium usually promotes relaxation to help people sleep. All I could say is listen to your body. For whatever reason, if L-carnitine or any other supplement is not agreeing with you, it’s probably best not to take it.
I have Hashimoto’s, and I’m wondering what your stance is on vaccines, particularly the shingles and pneumonia vaccine. I am 58 years old, and I am wondering if you ever recommend getting these vaccines. I am generally healthy other than my thyroid disease and arthritis. I have never received the COVID vaccine and only took the flu vaccine when I worked in a hospital, and it was required for employment. Thanks for all that you do.
Thanks, Joanne. You will get a biased opinion from me. I am not completely opposed to vaccines, but I can’t say I’m a big fan of them either. Everything is risk versus benefit. For example, I didn’t get the COVID vaccine either. COVID can trigger thyroid autoimmunity, so the vaccine or COVID could be a trigger. You don’t get the vaccine, and you can get COVID. Or you could get the vaccine, and the vaccine itself could be a trigger.
I recently turned 55. I’ve had shingles. I had shingles in 2016. It wasn’t fun to deal with it, but I made it through. Some cases are definitely worse than others. Pneumonia, I dealt with COVID pneumonia, which also wasn’t fun, in 2022. I don’t get sick a lot.
Shingles, in my case, was mild. The COVID pneumonia hit me hard. The vaccine is not specifically for COVID pneumonia.
I can’t tell you not to get these. I just focus on optimizing my immune system health, which is not perfect, but neither is the vaccine. There is a chance you could get a reaction. It could sometimes make things worse, like exacerbate Hashimoto’s conditions potentially. Like I said, it’s not always an easy decision.
For me, I won’t say it’s not an easy decision. It kind of is. To me, that’s my approach. Even when I got COVID pneumonia, I didn’t question not getting the vaccine. Same with shingles. I don’t think about it. To me, I feel very comfortable not getting them. Even if I were to get shingles again, because you can get shingles more than once, as well as pneumonia.
Up to you. Hopefully, this helps. Like I said, I am more biased. That’s my approach.
I’ll say this. Either way, you want to optimize your immune system. Even if you got the vaccine, it’s not a replacement for improving your immune system health, eating well, managing stress, getting sufficient sleep. This can all help to optimize your immune system.
There are other things that are supplements as well. Having healthy Vitamin D levels is important.
If you have a hot nodule, will you for sure have a flareup again after getting off of methimazole? If your numbers are looking good (T4, T3, TSH), or does that mean your nodules are calming down?
If you’re off the methimazole, and your numbers look good, and if they look good for a while-
Nodules are different than Graves’. If the nodule hasn’t been addressed, and someone gets off of methimazole, they usually become hyper really quickly. If you’re getting the cause of the hot nodule addressed, and you’re off methimazole, and your numbers look good at least for a few weeks, that’s a good sign.
If the hot nodule hasn’t been addressed, there is a good chance you will become hyper again.
I would like to know why I have severe symptoms for months, then am pretty normal. My T4 direct dialysis has been high for well over a year. T3 seems to be normal. TSH is borderline low and barely in normal range.
Kind of hyper. T4 is high. T3 is okay. TSH is low. Been on cabergoline and just changed to methimazole a couple months ago by a new endocrinologist. Have no diagnosis other than maybe hyperthyroid.
I wonder if she meant carbimazole because cabergoline is different. That’s a different medication. You’re on methimazole right now and have no diagnosis other than hyperthyroid. Had a goiter 10-12 years ago that went away with no treatment other than a short-term beta blocker.
Symptoms are not quite the same. You are not having weight loss or heart racing as before. Chills, headaches, mouth sores, itching, diarrhea, muscle weakness and pain, extreme fatigue, and can’t sleep for more than four hours uninterrupted. What can I do? I feel like I’m going insane.
You said you’ve had these symptoms for months. Your T4 has been high for over a year. I don’t know if you’ve tested for Graves’. With Graves’, usually T4 and T3 are high, and TSH is undetectable, not just borderline low.
Subacute thyroiditis, usually both are high. It’s usually caused by a virus, which can cause some of these, the chills, headaches, mouth sores, weakness. Usually, subacute thyroiditis is transient. It doesn’t last for over a year.
Based on this, that’s why it’s always good, in all cases, but this is a little bit unique, this case of hyperthyroidism. I definitely would recommend working with a practitioner. Doesn’t mean it has to be me, but someone else who has a lot of knowledge of hyperthyroidism.
With someone like you, I’d love to go through the case history. Look at other blood tests. Definitely some basics, like a CBC, a comprehensive metabolic panel. We probably need to dig deeper.
I am saying “we,” but it doesn’t mean you need to work with me. I would work with someone. Chances are your medical doctor is just going to say to keep taking methimazole, whether it’s a primary care doctor or endocrinologist. They won’t look into the cause of the problem.
Besides the thyroid numbers not looking normal, all these symptoms are affecting your quality of life. You’re not going insane because you definitely have an imbalanced thyroid. Those symptoms are really negatively affecting your daily life. Like I said, I would work on-
You definitely want to get those numbers. The T4 has been high, and that could affect some of these symptoms: sleep, muscle weakness, diarrhea. I can’t say that hyperthyroidism commonly causes chills and headaches and mouth sores. Some of these others, it could. Not everybody has fatigue with hyperthyroidism, but it does put a lot of stress on the mitochondria, the energy powerhouses of the cells. Like I said, I would work with someone.
I wish I had quick answers for questions like these. That’s the thing. Sometimes, I do have a quick response. Other times, you really need to dig deeper. This is one of these times.
When it says you can’t eat any food before taking levothyroxine or Synthroid, does that also include not drinking anything like coffee or juice until after the half hour or hour?
Ideally, you want to avoid everything, even coffee, juice, even green tea. Wait at least an hour before taking the thyroid hormone replacements.
I found out about my hyperactive thyroid through a routine fertility check in September 2025. My TSH was .01. My T3 and T4 were well within the normal range. I was diagnosed with Graves’ about two months later and started taking 50mg of PTU three times a day. Eager to get everything sorted out in the hopes of getting my body ready for pregnancy. I have since learned that this process is more complicated. My neutrophils dipped into the mid-500s, which made me nervous. I stopped taking PTU, and I’ve started taking Thyroid Calming, one teaspoon three times a day. I have bugleweed ready when that bottle is gone. My functional doctor suspects an underlying infection, like a parasite, causing my immune system suppression. I did a tick panel through Vibrant Labs and am following up with a toxo test today. Throughout my process, I am completely asymptomatic. What would you suggest to do from here?
Obviously, I can’t tell you to stop the medication. You already stopped the PTU. At the very least, it’s good that you’re trying to do something to manage symptoms. Thyroid Calming and making a transition to bugleweed. That can help potentially manage the hyperthyroid symptoms. While doing that, you want to address the cause of the problem, which it looks like you’re looking to do.
I don’t think you mentioned changing your diet. Maybe you are already eating a healthy diet. If not, definitely check out my book The Hyperthyroid Healing Diet.
It could be infection. Looking at parasites, ticks, a toxo test for environmental toxins. Don’t overlook the basics, like nutrient deficiencies as well as having healthy adrenals, for example.
I think what you’re doing is really good. Make sure you incorporate the foundations: healthy diet, stress management, proper sleep. See what these tests show. You’re doing something to find triggers. When dealing with Graves’, you want to find and remove triggers; do things to heal the gut.
I think you’re doing great. I’m not sure if you’re following the foundations of healing I just mentioned. Just like I said, there are other tests, like adrenal testing or DUTCH testing, to consider. I sometimes recommend a comprehensive stool panel, like the GI Map or GI Effects.
If you haven’t checked out my books, a lot of these questions would be answered as far as finding and removing triggers in Natural Treatment Solutions for Hyperthyroidism and Graves’, which is now in its third edition.
For Hashimoto’s, I have Hashimoto’s Triggers, which is comprehensive.
I am hypothyroid. No Hashimoto’s antibodies. Can I ever get off the thyroid hormones I have taken for 25 years?
25 years is a long time. It doesn’t mean that it’s impossible. It’s not necessarily the duration that you’re taking it, but the amount of damage that is taking place. The higher the dose of thyroid hormone replacement, the more difficult it will be to get off of it. If you’re on a lower or medium dose, I’m not saying it will be easy, but it won’t be as challenging.
You want to address the cause of the problem. If it’s non-autoimmune, what’s the reason? It’s not always easy to find that out. Maybe you’re exposed to a lot of endocrine-disrupting chemicals, like microplastics. You need to do things to reduce your toxic burden, for example. Maybe you need to address certain nutrient deficiencies.
I wouldn’t give up hope. I would recommend working with a natural healthcare practitioner.
I’m on 40mg of methimazole. My last blood test showed my alkaline phosphatase was 278. Should I be concerned? My PCP hasn’t addressed it, nor my endocrinologist.
I do have a podcast episode talking about alkaline phosphatase. It’s very common with hyperthyroidism. That is pretty high. I haven’t seen it that high before.
That usually relates to bone turnover. Some are concerned it relates to liver. I would focus more on ALT and AST with liver enzymes. The alkaline phosphatase usually is bone turnover, which is not great either. Over time, it could lead to low bone density. You might want to in the future consider a bone density test.
For now, I would continue working on getting those thyroid hormone levels down. You’re taking 40mg of methimazole, which is a pretty good dose. I’m guessing that’s going to help with the thyroid hormones. It should be just a matter of time before that decreases.
If it doesn’t start heading in the right direction, definitely check in again with your PCP. It is pretty common, and it could take a few months before you start seeing significant improvements.
I have Hashimoto’s thyroiditis. I am on levothyroxine daily for life. My thyroid metabolism is controlled by levothyroxine. I also have osteoporosis, which I understand can progress due to my hypothyroidism and my age, which is now 76. Other than bisphosphonate medications and resistance exercise, is there any way to slow the progression or reverse my osteoporosis?
I do have episodes where I have interviewed people on this, like Margie Bissinger, Kevin Ellis. The answer is yes. I am not saying there is not a time and place for medications. The bisphosphonates affect the osteoclasts, which break down bone, but there are medications such as Forteo which increase osteoblasts, which help build bone. I am not saying to do that. With the bisphosphonates, like Phosphomax, the side effects are definitely a concern.
Diet. Make sure you are getting enough Vitamin D, calcium, magnesium. For years, I overestimated the amount of calcium I was getting through green, leafy vegetables and broccoli. I don’t eat fish with bones, which is a really good source of calcium. If you are also not eating fish with bones, and you are not consuming dairy, then you might want to consider supplementing with calcium.
Now that I’m in a state of wellness, I started drinking goat milk kefir. I also supplement with some calcium. Some people are scared of supplementing with calcium. You don’t want to take massive doses of calcium.
According to the people I’ve interviewed, you should have at least 1,000-1,200mg of calcium per day. If you’re getting 800mg through diet, then you would want to supplement with 200-400mg per day, for example.
The resistance exercise is great. I use a vibration plate. I have a weighted vest, which is popular these days. You just want to be careful to start with lighter weights and build your weight up.
There is hyper resistance exercise as well. You might want to work with a personal trainer if you are not used to doing these exercises. Squats and deadlifts are really good. I don’t enjoy them, but they are good for bone density.
Can hyperthyroidism turn into hypothyroidism over time? Can having too much thyroid hormone turn into too little thyroid hormone?
We do see this sometimes. Especially if someone has the antibodies for both Graves’ and Hashimoto’s, someone might come in who has hyperthyroidism due to Graves’, but they also have the Hashimoto’s antibodies. In the background, it’s causing damage to the thyroid gland. Over time, they become hypo.
In this case, you’d want to address the autoimmune component of both Graves’ and Hashimoto’s. Thankfully, there is overlap between addressing those antibodies and immune system health. It’s not exactly the same. That’s why it’s always good to work with someone.
In my case, I focus more on Graves’, but I also wrote a book on Hashimoto’s. If someone has Graves’ who I am working with and has the antibodies for Hashimoto’s, I feel comfortable working with them. Like I said, there is a lot of overlap: finding and removing triggers, healing the gut.
I’m sure others would like to know the effects of their other medications and eating habits on levothyroxine and the thyroid.
It’s a pretty broad question. Different medications. If someone takes antithyroid medication, that will suppress thyroid. I wish it was more specific. I don’t know. There are too many medications to cover here.
If you’re on medication and are worried about interactions with levothyroxine, your prescribing doctor should know. The pharmacist should also know. They are more of an expert than I am. If you listed a bunch of different medications that I was not familiar with, I wouldn’t be able to answer interactions between them and levothyroxine. That’s why there are pharmacists. Many medical doctors are also not familiar with these interactions. That’s what pharmacists are trained in. They also have a database to refer to if necessary.
Eating habits depends. There is that myth that people with low thyroid should avoid cruciferous vegetables because they’re goitrogenic and will inhibit thyroid hormone production. Maybe if someone is eating very large amounts of raw cruciferous vegetables, that might be a concern in some people. In most people, that still wouldn’t be a concern.
My patients with Hashimoto’s and non-autoimmune hypothyroid conditions do not have problems eating cruciferous vegetables. If you cook them, even if you lightly steam broccoli, that will reduce the goitrogenic properties.
There might be other questions. Again, it’s very broad, so I can’t possibly cover all of the different foods here. I do talk about different foods on my podcast and in my books.
Can a subdural hematoma that I had in December 2011 cause my hyperthyroidism beginning in February 2017?
This isn’t one that will apply to most people. TBIs, traumatic brain injuries, are more popular. I have had some experts on the podcast talk about how TBIs can affect potentially the thyroid, the immune system.
No way to know for sure if it was responsible for the hyperthyroidism six years later. It’s possible, but there is no way to know 100%. I don’t know if there is anybody who could make that connection. A correlation doesn’t always mean causation of course.
What causes Hashimoto’s disease to flare up?
There could be different factors. I talk about different categories of triggers. Food for example. Different foods can cause Hashimoto’s to flare up. A lot of stress.
Being exposed to a virus. We spoke about COVID. I saw it more with Graves’, but I also see more Graves’ patients. Viruses can cause Hashimoto’s to flare up. Even if someone has the flu, that could exacerbate Hashimoto’s.
Being exposed to certain environmental toxins and toxicants such as mold could cause flareups.
In my book Hashimoto’s Triggers, a lot of those triggers can also cause flareups. They are triggers, meaning they can lead to Hashimoto’s, but if someone already has Hashimoto’s, many of the triggers I discuss in my book can actually flare up Hashimoto’s as well.
I have not been diagnosed with Graves’ or Hashimoto’s although my latest endocrinologist said the results did not say it was Hashimoto’s, but she thinks it was Hashimoto’s. What are the possible causes for my need for Armor and cytomel? Is this curable? Will I be on meds for the rest of my life? I’m 56.
It depends on the cause. If it’s Hashimoto’s, some people do need to be on thyroid hormone replacement permanently. Not everybody. It’s not autoimmune, so you are trying to find the cause of the problem. If it’s Hashimoto’s, then I could understand needing to be on some type of thyroid hormone replacement.
If you have problems converting T4 into T3, like if you have normal T4 levels and lower T3 levels, then that would explain being on T3 although the Armor also has T3. I don’t see a lot of people on desiccated thyroid like Armor and also take T3 separately. Most people would just be on desiccated thyroid, like Armor. That would be based on the thyroid numbers. If you have a TSH that is high, and thyroid hormone levels that are low or on the lower side, that would be an indication for Armor.
I have terrible pompholyx on the back of my hands [which is kind of like an autoimmune skin condition like an eczema]. It’s been there for at least eight years. In June 2023, I was diagnosed with Graves’ and had many subclinical symptoms prior, including the pompholyx. I went into remission from Graves’ in September 2024. In November 2024, I was diagnosed with Hashimoto’s. Is pompholyx a condition that comes about due to thyroid dysfunction? How can I best treat it other than using steroid ointments?
It is not connected to the thyroid, but it is connected to the immune system and the gut. Most immune system cells are located in the gut. I had Dr. Julie Greenberg on the podcast a few years ago; she is a naturopathic dermatologist. She reinforced that most skin conditions are caused by problems with the gut.
That is where I would focus. I would focus on improving your gut health, and doing that will improve your immune system health.
You might need to do this in other ways. If you have low Vitamin D levels, you might need to get the Vitamin D levels up. If you have low omega-3 fatty acid levels, gotta get those levels up. Selenium can help. Eating healthy diet, stress management, proper sleep, all those are important for optimal immune system health.
That would be the goal for 2026: focus on optimizing your immune system health. Doing a lot of this through improving your gut health.
This question probably should have been asked earlier, maybe even in episode one: Thanks for all your TLC and reporting on thyroid issues. My biggest question in dealing with Hashimoto’s for several years is why can’t I lose weight? It seems impossible to lose even a little and then expect it to stay off.
There are some people with Graves’, hyperthyroidism, and other types of hyperthyroid conditions. Many people lose weight, like I lost a lot of weight. I also work with people who can’t lose weight.
With Hashimoto’s, it could be the thyroid. With Graves’, it wouldn’t be the thyroid. With Hashimoto’s, your thyroid could be low. A lot of people have okay T4 levels, but they have problems converting T4 into T3. T3 is the active form of thyroid hormone.
High cortisol can cause problems with weight. Insulin resistance or leptin resistance. Those many times go together. Even increased toxic burden can make it difficult to lose weight.
Again, working with someone, you maybe already have worked with different people. You probably have done a lot from the diet perspective. It’s still important to eat a healthy diet, manage your stress, and get sufficient sleep.
In addition to that, you might want to do adrenal testing. See what your cortisol looks like. Healthy gut microbiome. There is a lot of research showing that gut microbiome imbalances can make it difficult to lose weight. Doing some testing for blood sugar, not just hemoglobin A1C and fasting glucose, but fasting insulin. Also looking at leptin as well. Doing as much as you can to reduce your toxic load.
I understand. It can be difficult. I am in my 50s now. Not that I’m necessarily trying to lose weight. I could more easily gain weight than I could in the past. It’s not as easy to lose weight. It was much easier to lose weight in the past.
As we get older, that’s also an issue. You don’t put your age, so for all I know, you could be in your 20s or 30s, so that might not be a factor. If you are in your 40s, 50s, 60s, I hate blaming age because it’s not just age. I know I have to work harder.
Staying active is important. I do a lot of walking and resistance exercise. If you do resistance exercise, you will build up muscle. You might not lose weight on the scales, but you are losing fat. You need to consider that as well.
I have a question about iodine. I have read so many conflicting things. Some say for example supplementation is desirable with Hashimoto’s. Others say it’s dangerous. As usual, I suspect the truth is somewhere in the middle. Can we test our iodine levels to get a feel for whether we need more, less, or the same? If you have time to answer this and feel it would benefit others, it would be great to hear your insights.
You could test for iodine. There is no perfect way of testing for iodine. Blood isn’t a great way. Urine is better. It’s still not perfect. There is a lab for those in the United States, Hakala Labs. They do urinary testing. They do spot urinary testing.
Iodine loading testing. A little bit risky because you are taking a 50mg tablet of potassium iodide and measuring the excretion. I have done it before. I did fine. Some people don’t do fine.
Everybody is different. I have had good experiences with iodine. I am cautious about iodine in my patients. Separate iodine supplements or even eating foods that are really high in iodine.
I have noticed that some people don’t do well with iodine. There are different reasons. I understand someone needs to have healthy antioxidant levels, like if they take iodine and don’t have healthy selenium, that could cause a lot of oxidative stress. There is iodine and the other halides like bromine and chloride. Sometimes you get a detox reaction.
There are also other factors. I have had moreso with Graves’ because I see more people with Graves’, but with Hashimoto’s, it could exacerbate Hashimoto’s. I talk about this in my book, too. I see at least a few times a year people with Graves’ where it seems like it was initiated when they took iodine supplementation. Not usually when they eat foods high in iodine. Even iodine contrast could be a concern. I have a podcast episode on that.
Testing is always a good idea, but the testing is not perfect. If you’re low on iodine in the urinary test, I would be careful about supplementing separately without working with a practitioner.
First of all, happy 2026 to you. Secondly, please excuse my English; I’m from Spain. Diagnosed with hypothyroidism about eight years ago on silent reflux with slow, difficult digestion. I have been feeling very cold with lots of muscle pains and cramps from some months. I thought it was my thyroid and asked for some tests from my family doctor. My TSH looked very normal at 1.66. I take 15mg of thyroid hormone replacement. Ferritin was very low at 7ng/ml. Could the ferritin values explain all the cold and muscle pains? Is there a link between low ferritin and low thyroid function and digestive problems?
I have written about this. Iron is important for optimal thyroid health. If you have low thyroid, it could be a factor and thereby cause some of those symptoms.
I wouldn’t say low iron would cause digestive problems. Usually, it’s the opposite. Having digestive problems can cause low iron and low ferritin.
You mentioned you suspect you suffer from hypochloridria, low stomach acid, which definitely could be a factor. Low thyroid could cause hypochloridria. So can other factors. Even chronic stress can cause low stomach acid as well.
You have been taking butane HCl for the last 10 days prior to sending this. Protein digestion feels better.
There is a time and place for supplementation with iron. You also want to do things to address the iron deficiency. You’re 68 years old, you mentioned, so you’re not cycling. You’re not menstruating, so you’re not losing blood that way.
You said no blood in the feces according to the test. There is no GI bleeding. I am thinking that gut health, even if you are not having GI bleeding, if you are having low stomach acid, maybe H-pylori or SIBO. A lot of things can cause maldigestion, malabsorption of nutrients.
My husband is hypothyroid. Before taking medication, his only symptoms were cold hands and feet and hair loss in his armpits, calves, and eyebrows. His TSH was around 9 or 10. He is very thin and muscular with pretty good energy at age 68. He has tried all sorts of thyroid meds, compounded T3/T4, NP thyroid, glandulars. The only thing that moves is his TSH, which goes down between 1-2, which is great. However, T3, T4, free T3, free T4 are all at the bottom range or lower.
TSH is looking good, but your husband’s thyroid hormones are on the lower side or maybe even below the range.
How concerned should he be? Is he just chasing numbers instead of going by how he feels?
There is concern. I would recommend working with someone because the body is complex. Everybody is different.
It’s great that the thyroid replacement hormone is helping with the TSH. Of course, the thyroid hormones are important. It does seem like they are helping with the thyroid hormones.
I don’t know if he has some thyroid hormone resistance going on, like insulin resistance, where the thyroid hormone in this case is not getting into the cell. That is a possibility. Focusing more on the receptor, like Vitamin A, zinc, omega-3 fatty acids.
It’s another reason to consider working with someone. It’s been a frustrating journey for a very long time. Most medical doctors and endocrinologists will look at TSH and probably say it’s okay based on that number. I definitely don’t agree with that. I would say to work with someone. Find a natural health care practitioner who has experience with hypothyroidism.
Like I said toward the beginning, some cases are more complex than others. I wish I could solve every question. When you don’t have to get any more information, don’t have to consider working with someone. In this case and some other questions that I answered, it would be a good idea to work with a practitioner.
That is it. Between the first episode and second episode, we went a while. Well over an hour, which is why I split this up into two episodes. I didn’t want to go an hour and a half. It’s fun to do this. There are some great questions. I apologize for any questions I didn’t get to. Good amount of questions I didn’t get to unfortunately. Thanks for sending your questions. I will be doing this again sometime in the future.
Best of health, everybody, in 2026. Happy new year. Tune into future episodes. Look forward to catching you in the next episode.