In this Q&A episode, Dr. Eric Osansky answers listener questions focused primarily on hypothyroidism, Hashimoto’s, and general thyroid health. He starts with iodine exposure from CT contrast and the nutrients needed for healthy thyroid function, then explores how symptoms like hair loss, fatigue, thinning eyebrows, and temperature changes can overlap with thyroid dysfunction, perimenopause, nutrient deficiencies, and other underlying imbalances.
Dr. Eric also tackles questions about thyroid hormone replacement, including natural desiccated thyroid versus synthetic options, difficulty tolerating medication changes, thyroid hormone resistance, and whether it’s possible to eventually reduce the need for thyroid medication. He discusses thyroid nodules and goiters, low ferritin, medicinal mushrooms, autoimmune gastritis, secretory IgA, persistent leaky gut, food sensitivities, parasite cleanses, and why identifying underlying triggers is often more important than simply adding more supplements.
Throughout the episode, Dr. Eric emphasizes that thyroid care needs to be individualized. Lab values, symptoms, immune health, gut health, nutrient status, medications, and the underlying cause of thyroid dysfunction all matter when deciding what steps to take. If you want practical answers to common thyroid questions—and a clearer understanding of what may be influencing your thyroid health—you’ll get a lot out of this episode.
Click Here [1] to listen to it on the Save My Thyroid podcast
Dr. Eric Osansky:
In this episode, I am going to answer multiple questions related to thyroid health. While I wish I could answer all of the questions sent to me, there were a lot of questions emailed. I choose questions that I think can benefit a lot of people with thyroid and autoimmune thyroid conditions.
Since there were so many great questions, I’ve decided to do this in two parts. This episode will focus on hypothyroidism, Hashimoto’s, and other more general thyroid-related questions. Next week, I’ll release the second part, where I will answer questions related to hyperthyroidism, including Graves’, toxic multinodular goiter, and other hyperthyroid-related questions.
Let’s get started.
I would like to know more about the dangers of having a CT scan with contrast.
I’m glad this question was asked. I decided to answer it first because recently I had an interview with Dr. Angela Mazza, who is an integrative endocrinologist. She has published a lot of articles related to thyroid health, including one on iodine.
With CT scans, there are different contrast mediums. It’s not just iodine. With iodine specifically, there are some case studies of people receiving a CT scan with iodine contrast and either triggering or exacerbating their autoimmune thyroid condition. Potentially it could trigger hyperthyroidism that is not autoimmune.
When I interviewed Dr. Mazza, we were discussing this topic. She didn’t seem too concerned about the CT scan with contrast. I have a Q&A podcast episode from a few years back. When I was speaking with Dr. Mazza, I didn’t remember everything that was discussed in the episode. I was thinking about having another updated episode, talking about CT scans with contrast, just to warn people that it could be problematic, even though she didn’t think it would be a big problem. She might have said if someone does become hyper, it probably would only be temporary. With iodine, that’s not always the case.
I’m not saying there is never a time and place for a CT scan with iodine as a contrast agent. I did want to mention that you want to be cautious if you do decide to get that.
We learned that iodine and selenium are very important for thyroid health. What are other essential nutrients needed for optimal thyroid health? What is the safest dose and sources of iodine?
I have recently learned that mustard seed is one of the best sources of selenium. Brazil nuts are a good source of selenium as well.
Essential nutrients for optimal thyroid health. Iodine is definitely important. Selenium does play a role as well. Iron is very important for thyroid hormone production. The amino acid tyrosine is also important.
When it comes to safest doses and sources of iodine, everyone is different. That’s the problem with iodine. You might want to refer to the conversation I had with Dr. Mazza. I have also had separate solo podcast episodes and written articles on iodine; you might want to check those out. I have a Substack article that I released not too long ago that relates to iodine and hyperthyroidism specifically. My books Hashimoto’s Triggers, Natural Treatment Solutions for Hyperthyroidism and Graves’, and The Hyperthyroid Healing Diet all discuss iodine.
The truth is, everybody’s different. I am cautious about separate iodine supplements, especially talking about this here on the podcast. I’d hate for someone to take a separate iodine supplement, and it aggravates or causes hyperthyroidism or exacerbates an autoimmune component.
I am not concerned about iodine in a multivitamin. I know some practitioners are. Rarely do I see problems with that. It’s usually taking iodine separately. Higher food sources of iodine such as kelp for example could be a concern.
A safe dose for one person might not be a safe dose for a second person. In the book The Hyperthyroid Healing Diet, I mentioned 500mcg is a dose a lot of people can tolerate. Some books say 200mcg is the threshold. The truth is everybody is different. Without question, once you get into the mg doses of iodine, then it’s more problematic.
For sources, stick more with food sources, unless you are working with a practitioner, other than the iodine in a multivitamin. I rarely see a problem with that. Dr. Mazza also brought that up during our conversation. She is a little bit more conservative with multivitamins. It all comes down to everybody being different.
Can hair thinning and hair loss be tied to thyroid issues like Hashimoto’s? I’m just learning I have the antibodies for Hashimoto’s, and I’m trying to learn what that means for a 48-year-old navigating this new health information. How do you figure out if a symptom like hair loss or hair thinning is caused by perimenopause versus Hashimoto’s? Can the two be related?
Yes, without question. I have actually been on a few summits related to perimenopause and talking about the differences. Hair loss can be tied to the thyroid hormone imbalance associated with thyroid conditions or autoimmune thyroid conditions like Hashimoto’s. If you do a blood test and look at the thyroid numbers—TSH, free T4, free T3—you can see if the thyroid is within an optimal range and not just within the lab range.
Also, sex hormone imbalances associated with perimenopause can also potentially cause hair loss. If you have imbalances in estrogen or progesterone, that could be a factor.
If someone has Hashimoto’s and is in perimenopause, it could be at times challenging to know if the hair loss or other symptoms are associated with the thyroid condition or perimenopause. For example, perimenopause and Hashimoto’s can both result in fatigue. If you have fatigue, and the thyroid hormones are not in balance, and you’re also in perimenopause, it’s hard to know which one it’s related to. On the other hand, if the thyroid panel is looking good, maybe it’s related to perimenopause, but it could be related to adrenals. A lot of things cause fatigue.
Getting back to hair loss, nutrient deficiencies can play a role. There can be other factors as well. It is challenging to know exactly what is causing it, which might sound frustrating. That’s why we don’t just focus on one thing usually. I’m not just looking at the thyroid panel and thinking we can just normalize the thyroid panel. I also do things for the sex hormones. Many times, I’ll do things for the adrenals because you need healthy adrenals to have healthy sex hormones. I never focus just on the thyroid and neglect the adrenals or the gut, which a healthy gut is important for digestion and absorption of nutrients that also could play a role in hair loss.
I don’t usually recommend just focusing on one area. There definitely could be a relationship between the two.
I wonder what you think about medicinal mushrooms. I’ve taken reishi powder in combination with Vitamin C and selenium mixed in water in the morning. Sometimes reishi powder with magnesium in the evening. Do you have any experience with medicinal mushrooms? Whether extract is better than powder?
Thanks for your question, Monica. I have a podcast episode or an article on medicinal mushrooms. I have a product Hepatommune Supreme that supports the liver and has immune support, including reishi, cordyceps. These mushrooms seem to be more immunomodulating. Some call them “immune stimulating.” As a result, they recommend for people with especially Graves’ or Hashimoto’s to avoid these. I haven’t seen that with not only these but with other medicinal mushrooms.
Whether extract is better than powder, that I’m not sure about. Hepatommune Supreme is in capsule form, not extract form. With herbs, I often recommend capsules. For those with hyperthyroidism, usually I recommend bugleweed or motherwort in an extract because it’s typically better absorbed.
Disclaimer: everybody is different. I haven’t seen many problems with medicinal mushrooms. Of course, always work with a health care practitioner. My experience with people with both hyperthyroidism and hypothyroidism has overall been positive.
I have Hashimoto’s hypothyroidism. I take a T3/T4 medication. My TSH is always high. However, when I increase my dose even a minute amount, I get hyperthyroid symptoms. My other thyroid blood tests are in the normal to low normal range. Do you have any suggestions?
You take a T3/T4 medication, and TSH is always high. I wish I knew what the TSH was. Is it above the actual lab range? Is it 5, 6, or double digits? Is it within the lab range but higher than optimal? Either way, it’s at least higher than optimal.
When you increase the dose of your T3/T4 medication, even a very small amount, you get hyperthyroid symptoms. This is where speaking with this person might be helpful because as the hyperthyroid symptoms persist, do they last longer than a few hours or days? How long do they last?
You mentioned your other thyroid blood tests are in the normal to low normal range. I’m assuming this is after increasing the dose a small amount, too. You might have some thyroid hormone resistance, just like insulin resistance, where the hormones bind to the receptor. With insulin resistance, you have too much insulin, but it can’t enter the cell, so you are not getting the benefits of the insulin. You need to do things to address insulin resistance. You can have thyroid hormone resistance, where you have too much thyroid hormone, but it’s not entering the cell.
On a blood test, it doesn’t look like hyperthyroidism. It might feel like hyperthyroidism, but in the blood test, the TSH could be elevated. Many times, the thyroid hormones are in the normal range. Sometimes, in the upper range. Even though the TSH is normal, usually the thyroid hormone resistance, it’s not low normal. This is what it sounds like. Without doing a comprehensive health history, I’d suspect potentially thyroid hormone resistance.
How to address thyroid hormone resistance? Inflammation can cause this. Deficiencies in certain nutrients, like zinc and Vitamin A. Omega-3 fatty acids are important. That’s what I’m suspecting, at least with what you included in the question here.
Dr. Eric, since I had my thyroid radiated years ago, I am most interested in knowing how to replace what I need to offset the loss with something that is natural, not chemical.
It sounds like you got radioactive iodine. You don’t want to take levothyroxine, Synthroid. You want to avoid synthetic thyroid hormone.
One option would be natural desiccated hormone. It’s still a prescription, but it’s not the same as synthetic T4. With desiccated thyroid such as NP Thyroid, Armour, it has T4 and T3 and T1 and T2.
Every now and then, someone will ask, if they don’t have a thyroid, or even if they have an intact thyroid but need thyroid hormone replacement, if there is an alternative to thyroid hormone replacement. Especially if someone has their thyroid gland removed or gets radioactive iodine, and they absolutely need thyroid hormone, there is not an herbal replacement for thyroid hormone.
You would need to take something. If you don’t want levothyroxine, then maybe look into the desiccated thyroid. There is also glandulars, like Natural Thyroid Solutions is a company that offers glandulars with thyroid hormone over the counter. In this situation, I would ideally recommend working with someone.
What is the most effective way to treat hypothyroidism? Is there a cure?
This question is quick but difficult to answer. Very broad question. I could spend an entire episode talking about this, which obviously I can’t do here. I have an entire book on this, but it depends on what is causing the hypothyroidism. If it’s Hashimoto’s, refer to my book. Other practitioners have books, like Dr. Izabella Wentz, who also has been on my podcast, and I’ve been on hers.
I am hesitant to use the word “cure.” With Hashimoto’s and Graves’, there is a genetic component. I feel like I have been cured from Graves’, but there is always a risk of it coming back. I usually use the word “remission,” and talk about permanent remission.
The point is, in many cases, you can restore your health. Every case or situation is different. I don’t know what is causing your hypothyroidism, your low thyroid levels. The most effective way will differ if someone has Hashimoto’s compared to a non-autoimmune hypothyroid condition.
I wish I could give you specifics. Say this is exactly what you should do. I don’t know if it’s Hashimoto’s. If it’s Hashimoto’s or Graves’, it all comes down to finding and removing triggers, healing the gut. I have books on that. I have podcast episodes on this. I have articles.
At what point do you think thyroid nodules that haven’t grown very much in three years need more investigation? Basic lab tests look good. Growth of 1-2mm on different sides. They also shrink or stay the same on other sides.
It’s a little bit controversial. If you ask most medical doctors, they would say maybe keep on monitoring, or maybe not even monitor it if you’ve done a thyroid ultrasound three years in a row, and everything is stable. Most medical doctors, including endocrinologists, would say maybe do another thyroid ultrasound in a few years rather than monitor it every single year.
In this situation, I think it’s fair. I always like to try to address the cause of the problem. If someone has thyroid nodules, I don’t want to say don’t worry about it. If they’re smaller, they’re most likely benign.
If they have other issues, like if they’re seeing me for Graves’ or Hashimoto’s and also have thyroid nodules, let’s try to address the nodules while we’re also addressing the autoimmune component. If someone just has small nodules, and that’s it, and their thyroid function is good, and everything else looks great, you could still try to address some of the underlying causes.
I won’t get into detail here about the causes. I do have other podcast episodes where I discuss this. The recent one I mentioned with Dr. Angela Mazza spoke about iodine, thyroid nodules, and goiters. There are other questions related to nodules and goiters. I also have solo episodes where I talk about these as well. The interview with Dr. Mazza, she spoke about addressing inflammation with nodules. In some of my episodes, I get more specific. Definitely listen to the interview I did with Dr. Mazza. You might also visit my website and type in “thyroid nodules.”
How to help kids diagnosed with Hashimoto’s? I have not been able to find much information on this at all.
The reason is it is more common in adults. Unfortunately, more children are developing Hashimoto’s. It’s not much different than with adults. It could be challenging with younger children. The goal is to find and remove triggers and heal the gut. If you were to read Hashimoto’s Triggers, I didn’t write that for children. Most of the information will apply to children, too.
With dosing, it gets tricky. That’s why in this case you probably would want to work with a practitioner, especially if it’s a younger child. When I say “younger child,” I mean single digits. 10 years and under. At any age, it’s good to work with someone.
The concept is the same. The approach is the same. Find and remove the triggers, and heal the gut. There is a time and place for thyroid hormone replacement as well.
I have a question about what are the signs that your thyroid is not functioning properly? I have been diagnosed with a nodule on my thyroid, and my doctor said my tests were fine. I have had hair loss since 2015. My energy is low. I’m tired daily. My eyebrows are very thin. The doctor never tested T3 and T4 to see if they are functioning properly. What can I do to combat these symptoms and feel better?
It does sound like it might be related to your thyroid with some of these symptoms, maybe not the nodule. It sounds like they just looked at TSH, which is actually a pituitary hormone. Many times, TSH is not within optimal range. I like to see it between 1-1.5. Even between 1-2 is still okay for many people.
Let’s say your TSH was 3.5 or 4. Most labs would consider that normal. As a result, the doctor won’t do anything.
I agree that it’s probably a good idea to work with someone to get those labs done, to look at T3 and T4 and maybe other blood tests, like antibodies.
A lot of things can cause fatigue. I mentioned earlier some of the factors that can cause hair loss. These days, you could order your own blood tests if absolutely necessary. That is something to consider if you don’t want to see another doctor, or it will take some time to see another doctor. Or you’re worried they won’t recommend the testing.
At least in the U.S., it is pretty easy in most states to get blood testing. In other states like NY and some of the surrounding states, you might have to drive to PA or somewhere else to get blood tests.
That’s what I would recommend. Don’t just rely on TSH but get a full thyroid panel. Good idea to get antibodies as well.
I have been struggling with hypothyroidism, low thyroid, for over 20 years. I have been taking thyroid medication. A few months ago, my dosage was increased to 90mg of NP Thyroid from 75mg. Subsequent bloodwork revealed I am not converting T4 to T3. I was placed on liothyronine sodium, which is pretty much synthetic T3, 5mcg, twice daily. My most recent bloodwork indicated I was still deficient in T2.
They don’t test T2 in the blood; I’m thinking something in T3, since you were taking the 5mcg of the synthetic T3. You’re still deficient in T3, so the dosage was increased to 10mcg twice daily instead of 5mcg.
My problem is the increased dosage has rapidly reduced my weight. I am a petite, slender woman, and I am now so thin that my size 2 clothing is way too big. What can I do?
It sounds like you’re taking too much thyroid hormone. I can’t tell you to stop or reduce it. I don’t have prescribing rights. Even if I did, you’re not a patient of mine, so I can’t tell you to decrease it. It seems obvious that you’re taking too much. I would reach out to your practitioner and bring this up.
I don’t know if there are any other signs of hyperthyroidism, like if you’re having increased resting heart rate. I would bring this up to your practitioner. If your practitioner blows you off, go to a different practitioner who will pay attention to you. If you’re losing a lot of weight, it sounds like you’re hyperthyroid.
Could it be something else? Could it be coincidental, and there is something else going on with your gut? Yeah, of course there could be. You would want to have that investigated and not just have the doctor say, “Don’t worry about it.” At the very least, do an updated thyroid panel, and see what it looks like. See if you’re taking too much thyroid hormone.
It seems since it started happening when you doubled the dose of the T3 that it’s related to the T3. It certainly could be something else, like gut-related, as well, or instead of the thyroid. It could be both. You never know. Like I said, I definitely would do an updated thyroid panel.
Are multivitamins with iodine not a good idea for those on thyroid meds?
I kind of already answered this, but this specifically asks if it’s a good idea for those on thyroid meds. They didn’t specify if it was meds for hypothyroidism or hyperthyroidism. With hypothyroidism, it’s likely thyroid hormone replacement. With hyperthyroidism, you would be on antithyroid medication.
In either of those situations, I usually don’t see any problems with people taking multivitamins with iodine. Usually, the iodine would be 50-200mcg in a multi. Even with the higher amounts, like 150-200mcg in the multivitamin, I typically don’t see problems with that. That’s been my experience when it comes to taking iodine with thyroid medication. I have not seen it negatively decrease the effectiveness of the medication.
Antithyroid medication does affect the production of thyroid hormone that also ties into iodine. Iodine is important for thyroid hormone. You might not get as great of a benefit from the iodine that is in the multivitamin if you are taking antithyroid medication. I wouldn’t say it’s not a good idea. If someone needs a multivitamin, I would recommend it. I won’t recommend a multivitamin that is iodine-free. I typically recommend a multivitamin that has iodine.
What can I do to get off Synthroid?
A quick question, but not an easy question. I can’t tell you this is what you should do to get off Synthroid. I can’t give specifics.
There are a few different things. If you don’t want to take synthetic thyroid hormone, you can take desiccated thyroid hormone. if your goal is not to need thyroid hormone replacement to begin with, you want to address the cause of the problem.
When I work with someone, I’m not always successful in getting someone off of thyroid hormone. When I do, it’s because I’m addressing the cause of the problem. For example, with Hashimoto’s, it’s an autoimmune condition, so we address the immune system. As long as there is not too much damage done to the thyroid gland, many people can get to the point where they don’t need, whether it’s Synthroid or desiccated thyroid.
If someone is taking Synthroid, for example, if they don’t need it, they will start becoming more hyper. That will be reflected in the blood tests and how they feel. Based on that, the prescribing doctor will most likely reduce the dose. Someone would continue following that pattern until they ideally no longer need the synthetic thyroid hormone. I’m not telling them to wean off of it or stop it. Their numbers are telling the prescribing doctor to do that. Ideally, you want to get to the root cause.
If you have Hashimoto’s, which a lot of people have low thyroid hormones but don’t know if they have Hashimoto’s. I would recommend testing the TPO antibodies and TG antibodies. You might have already had this done, but you didn’t mention any of that, which is understandable. Maybe you didn’t know I was going to bring it up.
If you have Hashimoto’s, maybe check out my book Hashimoto’s Triggers or another book on Hashimoto’s. A lot more research is out there related to Hashimoto’s than Graves’.
I have a goiter. It’s large, and I’ve had it since I was 50. I’m now 66. My blood tests, according to the doctors, are all normal. Is it possible to reduce its size with just diet and supplements? What about iodine? I’m not on any medications.
For both of these questions, you might want to refer to my interview with Dr. Angela Mazza since we spoke about iodine and goiters. It depends on the goiter. It sounds like it’s pretty large. It is possible to reduce it and, in some cases, normalize it. I will say the larger the goiter, the more challenging it is, and the less likely it is to get it 100% normal. Whomever you work with might be able to reduce it a good amount, but if it’s extremely large, it might not be able to get back to normal.
Of course, my goal is to try to save people’s thyroid glands. There is a time and place for surgery. If someone has an obstruction, difficulty breathing, swallowing.
During the conversation with Dr. Angela Mazza, she did mention radiofrequency ablation (RFA), using radiofrequency to shrink nodules as well as goiters. That might be something to consider. Ideally, you want to address the cause of the problem.
I also have some solo episodes on the podcast on goiters and articles on my website.
It is possible, but everyone is different. The larger the goiter, the more difficult. Is it still worth trying to shrink it? I’m going to be biased. In my opinion, yes. Like I said, if it’s causing difficulty breathing, swallowing, or both, I’m not saying you should get surgery. That’s a situation when surgery might be indicated.
When I dealt with Graves’, I had a mild goiter. Surgery wasn’t indicated in my case. The really large goiters, I’m still a fan of trying to address the cause of the problem and try to get as much decrease in size as we can. Like I said, it is more challenging with the larger goiters.
If you take thyroid medication, does your thyroid make less hormone?
If you take thyroid hormone, it’s a negative feedback mechanism. Your thyroid is going to decrease the production of thyroid hormone. That is one thing that can make it a little challenging getting off of thyroid hormone replacement. It’s not impossible.
Let’s say someone is taking 125mcg of levothyroxine, not because I love levothyroxine, but that’s what many people take. That’s a pretty high dose. If someone is taking a high dose like that, it is more challenging compared to if someone was taking 75mcg or 50mcg.
My doctor or pharmacist changed my prescription this last time to generic levothyroxine. I was told eight years ago by my endocrinologist to make sure I always get Synthroid when filling my prescription. Neither will tell me who is responsible for this change. I am being told nothing can be done to correct this. I am taking the generic, and I am continuing to get more symptoms as I did when I was first diagnosed eight years ago. I’m very upset because my body was doing so well prior to this change. Any suggestion if anything can be done, such as stop taking it until I can get my next 90-day prescription filled correctly?
I can’t tell you to stop the prescription and wait. If your current doctors aren’t cooperating, and you just don’t feel well on the generic, I would say to switch doctors rather than stopping your medication. That would be my solution, not to keep on taking it. I’m also not going to recommend to stop taking it. I’m going to recommend to switch to a different doctor. Maybe before switching, call the office. Speak with the receptionist. Explain the situation. They might say, “We don’t know until you see the doctor.” I would definitely look for another practitioner if they are refusing to switch you back from the generic to Synthroid.
I am not a huge fan of Synthroid, not that I am a big fan of generic levothyroxine. Some people do feel good on Synthroid. If I had to take thyroid hormone, I’d prefer desiccated thyroid. If I was taking synthetic, Tirosint, which is more hypoallergenic. Some people do feel good on Synthroid. I know it’s inexpensive. It’s covered by many insurances. I can understand why some people choose to take it. Not to mention most doctors recommend it as well.
Bryan “Don’t Die” Johnson has been diagnosed with autoimmune gastritis. He has managed hypothyroidism for decades. It’s been implied that those with both hypothyroidism and hyperthyroidism often get autoimmune gastritis. I hadn’t heard about it. What do you think? Is it really that common? Also, what roles do your genes play in this?
Just like with all autoimmune conditions, there are some genetics. Most people with hypo and hyperthyroidism do not get autoimmune gastritis. When you say, “It’s been implied that people with thyroid imbalances often get autoimmune gastritis,” I disagree, at least from what I’ve seen. I’ve been working with autoimmune thyroid patients since 2009, so close to 17 years.
If you have one autoimmune condition, you are more likely to have other autoimmune conditions in the future. There is no guarantee that you will get autoimmune gastritis or other conditions. It’s not something I can say I commonly see in my patients with thyroid conditions.
I’m suffering from hypothyroidism/Hashimoto’s. I’m experiencing hair loss and thinning. I’m using medicine since I was 14, and now I’m 40. Lately, my ferritin levels have gotten really low, down to 2. Is there a correlation between Hashimoto’s and low iron? Can you give me advice with diet and other methods to raise my ferritin level considering I’m a vegetarian?
A ferritin of 2 is really low. I will say I like to do a full iron panel, not just ferritin. I like to look at iron, iron saturation, total iron binding capacity. There is a relationship between low iron and hypothyroidism, but not specifically Hashimoto’s. Iron isn’t necessarily causing Hashimoto’s. It’s not like the Hashimoto’s is causing the ferritin to be that low.
Being a vegetarian could be a contributing factor. It is more challenging to get iron as a vegetarian. Vegetarian sources of iron are not as bioavailable as animal sources of iron.
If you were my patient, I can’t give you specific recommendations. If someone had a ferritin of 2, assuming the iron and iron saturation were also low, I would recommend iron supplementation.
There could be other factors. You’re 40, so there is a good chance that you’re still cycling. That will cause some loss of blood every month. Gut problems sometimes can cause low iron. Might want to evaluate that. If someone wasn’t a vegetarian, I would recommend eating some red meat. I have some patients who are vegan or vegetarian. Typically, if iron is that low, especially in someone who is menstruating every month, supplementation. I can’t give specific recommendations, but I commonly recommend iron glycinate or bisglycinate.
Thank you for this opportunity. I don’t suffer from Graves’, but I have an enlarged thyroid with nodules that push my throat aside. The blood results are on the edge of being bad. My TSH is very low, .219. T4, 18.12. T3, 4.34 pm/l. For one year now, I’ve been taking L-carnitine, 3000mg; selenium, 100mcg; and 6mg of myoinositol per day. I am taking L-carnitine to prevent heart rate anomalies. I have no complaints, but how about the dosage? Is it necessary to take all three? Is there another supplement to take?
This is a situation where I can’t give specific recommendations or dosing. I will say that 300mg is a healthy dose of L-carnitine. There is a recent study from 2025 using 500mg of L-carnitine. This was specifically in Graves’ patients. You said you don’t have Graves’. Some of the other studies involving L-carnitine and hyperthyroidism use between 2,000-4,000mg of L-carnitine per day. I’m not specifically telling you to take that, but those are doses I commonly recommend to patients.
Same thing with patients with selenium. I often would recommend 200mcg.
I don’t recommend L-carnitine in everyone, or myoinositol. Most people I recommend selenium to.
As far as other supplements to take, I took bugleweed. With your numbers, I’m not saying you necessarily need it. Some people are fine with just L-carnitine. Some people take bugleweed. Some people take both. There are a lot of other supplements.
When you ask if it’s necessary to take another supplement, I assume you’re asking based on the numbers. Based on the numbers, if I was working with you and not recommending L-carnitine, I might recommend bugleweed. You’re not extremely hyper as far as your TSH is not undetectable. Your T4 is a different range, so I’m not sure where you’re located, if you’re outside the U.S. Your numbers in Europe, 18.12 would be on the higher end, but within the range. The T3, I would say optimal between 3.5. Some labs would have 4.34 as elevated, and some would have it on the higher end of the range. In your situation, I might not even give bugleweed. If I did, it would be a lower dose.
As far as other supplements, that really depends on what we find. If someone has an enlarged thyroid and nodules, then we’d look at problems with estrogen metabolism, sometimes insulin resistance. I would listen to some of my podcast episodes where I talk about goiters and nodules, including the interview I had with Dr. Angela Mazza.
I have hypothyroidism. I am in my 70s. I am on a low dose of NP Thyroid, diagnosed in 2008. Can my thyroid ever be fully healed?
This question may have already been answered. You don’t mention if you have Hashimoto’s. It depends on the cause. Most cases of Hashimoto’s can be healed. I hate using the word “cure” because there are genetics behind it. Some people like to use “cure,” but restoring health is possible, not only with Hashimoto’s but many non-autoimmune cases of hypothyroidism. It really depends on the cause.
Just because you have been taking thyroid hormone replacement for about 18 years now, it looks like, it doesn’t mean that you can’t heal. Remember, Hashimoto’s is an immune system condition. Even if it’s not autoimmune, there is something causing it. I don’t want to say it’s ever too late. I will mention it depends on the situation.
There are other options, like cold laser therapy. I had on the podcast an interview with Dr. Kirk Gehr to talk about cold laser. There is also red-light therapy. The evidence and research seem to point more to cold laser in healing the thyroid and even in Hashimoto’s, helping with the antibodies.
Even if someone has had hypothyroidism for a long time, we still want to find and remove triggers and heal the gut. If someone is doing all of that, and their thyroid isn’t healing, their immune system isn’t healing, there are other options. Cold laser therapy in some cases is something to look into.
I have heard you say that secretory IgA can be low from stress. You stopped eating nuts and seeds, and yours improved. Can anything else cause low secretory IgA? If so, how do you know what is causing it? How do you fix it?
It’s not a leaky gut marker. When secretory IgA is low, it typically relates to leaky gut, which can be caused from stress or food or infections.
The way you know is through testing. With the nuts and seeds, that was through experimentation. With diet, you can change your diet. When I dealt with Graves’, there was no AIP diet. I was following more of a modified paleo diet. I wasn’t really eating eggs, but I was eating nuts and seeds. My secretory IgA was low. When I retested, it was still low. I didn’t know if it was the nuts and seeds. It could have been something else. It turned out that it probably was that because when I cut them out, it improved and normalized.
At the time, I wasn’t 100% sure it was the nuts and seeds. Stress definitely was a factor. My cortisol and DHEA levels were really low, and both of those normalized even though my secretory IgA didn’t. I was assuming that maybe it wasn’t related to stress and something else instead. In my case, I took a break from nuts and seeds. It could be infection.
When looking at different triggers—food, stress, chemicals, infections—I don’t focus on one at a time. I’m looking at testing. I always recommend diet and lifestyle changes. We usually focus on different areas at the time.
If someone’s secretory IgA is low, and we’re doing things from a diet perspective, from a stress management perspective, doing some other types of testing. Maybe there are other things we find, and we address those triggers and underlying imbalances. Secretory IgA normalizes. In that situation, we don’t know exactly what caused the low secretory IgA. Most don’t care as long as it normalizes and stays normal.
I have been challenged with gut issues, food sensitivities, leaky gut, etc., ever since being diagnosed with Hashimoto’s about a decade ago. I have tried so many things to try to improve my gut health, but nothing seems to stick long-term. What do you suggest for those like myself?
When someone has leaky gut, leaky gut causes food sensitivities typically. The food sensitivities are usually caused by a leaky gut. But the question is what is causing the leaky gut? What are the leaky gut triggers?
I’m not sure exactly what you tried. I’m assuming supplements, maybe drinking bone broth. Those can help, but when someone’s gut hasn’t healed, the question is why. What are we missing? Does the person have a parasite? SIBO? Is something else going on? Yeast overgrowth? Sometimes, it’s challenging. Testing isn’t perfect.
For example, we might do a comprehensive stool test on someone, like a GI Map or GI Effects or another one. Maybe they don’t show us having parasites, so the person and practitioner automatically assume, “You don’t have parasites.” Let’s say someone does a GI Map or GI Effects, and parasites are negative. At that time, I will assume the person doesn’t have it, but I’m not going to rule it out 100%.
If the person’s gut isn’t healing, maybe I’ll look into other things such as SIBO or yeast overgrowth. Yeast is tested on many stool panels but also is not perfect. Sometimes, we do need to do additional testing. For example, an organic acid test is in my opinion the best test for yeast overgrowth, including candida. If I’m suspecting that, even if it shows up completely negative on a stool test, I might do an organic acid test. There is a company called ParaWellness Research that focuses on parasites.
I’m not saying I do these tests on everybody, but on more challenging cases, we might need to dig deeper. If you’ve done everything you feel from a dietary standpoint. Stress is a factor, too. Everyone deals with stress, but it can affect the gut. Mold, mycotoxins.
That’s the thing, too. It’s not just about infections, like parasites, microbes, yeast, SIBO. We live in a day and age where we’re exposed to so many environmental toxins and toxicants. Mycotoxins, microplastics, glyphosate. You can’t completely avoid these, but we need to minimize these because these can disrupt the gut and cause a leaky gut.
I wish I had a simple solution, but it really comes down to removing the leaky gut triggers, not just taking supplements to heal the gut. I like supplements to heal the gut. I have a gut healing bundle that has a probiotic, a digestive enzyme, a gut healing formula, SMT GI Restore. If someone just takes the gut healing bundle, that’s usually not going to be enough. They usually need to do other things to find or remove triggers.
I do have a question for you: Can you discuss parasite cleanses and issues we may face if doing so?
Like I just mentioned, I honestly did not know Glen’s question was next. When I arranged the questions, I obviously read this question. I can’t answer every single question, so I chose the ones that would be more popular, where I think a lot of people would benefit. I didn’t know this question was coming up next though, so great timing.
I’m not a big fan of random parasite cleanses. That ties into what I just mentioned. If you do testing, and it’s not perfect, why treat everybody for parasites? I have had some people on the podcast who do that. Elizabeth Yarnell is a traditional naturopath who treats everybody for parasites, and that’s her approach. I’ve had others like Dr. Jason Hawrelak and Dr. Nirala Jacobi, who don’t do that. They are experts in the gut microbiome.
There is a time and place for treating. Since the tests aren’t perfect, if someone is not progressing as expected, and I am suspecting there might be a hidden parasite, an option is to do another test like ParaWellness Research. The functional medicine tests are expensive, so there is a time and place for doing a parasite cleanse.
I don’t recommend routine parasite cleanses. For example, I didn’t do a parasite cleanse prior to my Graves’ diagnosis. I didn’t take antiparasitic supplements, antiparasitic herbs. I’m pretty sure parasites didn’t cause my Graves’ condition. It might be obvious to some people, but some practitioners make it like parasites are the main reason for autoimmune conditions and chronic health conditions. They definitely can be problematic in some people but not everybody.
Like I said, I don’t just do random parasite cleanses. Obviously, if someone tests positive for a parasite, then yes, there is a time and place for it. Even if someone tests negative, and they are not progressing as expected, maybe in that case, we need to do a random parasite cleanse. Not suggesting specifically that you or Adam or anyone listening to this should do it. I’m not saying there is not a time and place for it.
I have been on natural desiccated thyroid for many years. Recently, my dose was reduced from 120mg to 90mg. How long should I stay at this dosage before getting retested? Would it be okay just to test the TSH? I know it doesn’t give a complete picture, but I haven’t been able to find a doctor I can afford to do the full panel.
There are some places where you can get a thyroid panel for $40-50, looking at TSH, free T3, free T4. I know DirectLabs.com, I used to use them, and they offer discounts. They have specials at certain times of the month. Once or twice a year, they have a thyroid month.
I understand money being tight in some cases, where even $40-50 might be a lot. The regular price can be more than that.
In my opinion, if the dose was just recently reduced, I would say probably about two months to retest.
Would it be okay just to test TSH? I would say ideally, you want to look at least TSH and free T4 and free T3. There is a time and place for reverse T3 and thyroid antibodies. As far as talking about the dosing here. TSH and T4 would be the minimum I would look at, not just looking at TSH.
I was wondering about raw A2 dairy. I know dairy should be avoided for Graves’ patients, but since A2 raw dairy is loaded with great probiotics and doesn’t contain casein like regular dairy, I was wondering if it might be okay.
It does contain casein; it’s just different. A2 dairy is still dairy, even though it’s definitely better than A1 dairy, regular milk. Raw milk has benefits. I get questions like this all the time about raw dairy, A2 dairy, goat milk.
On a wellness basis, I’m drinking goat milk kefir, so I’m not completely dairy-free. I’m not talking about this from a biased perspective in that I’m avoiding dairy because I’m not avoiding diary.
While healing, I usually do recommend all forms of dairy, even raw dairy. It doesn’t mean everybody will have problems with it, but especially if someone is working with me and paying money to work with me, and three months go by, and they’re not progressing as expected, and they have been consuming raw A2 dairy, I’m going to look at that first. “Well, maybe it is the dairy.” I’d rather just have them take a break from it initially.
If the person is not progressing after three months, at least we can’t blame it on dairy. If they are progressing, maybe they would have progressed even with the dairy, but they usually won’t complain as long as things are heading in the right direction. That’s my opinion when it comes to dairy when someone has-
Even though this is someone with Graves’, I should have mentioned in the beginning, even though the next episode will focus more on hyperthyroidism, something like this can also relate to someone with Hashimoto’s. There are a few hyperthyroid and Graves’ questions here. I should probably have brought that up initially. Hopefully, you will listen to this and not wait until next week’s episode.
Thank you for your email and all the excellent episodes on thyroid health.
By the way, a lot of people did say thank you. Many times, I jump to the question for the sake of time. I appreciate everyone who thanked me. Of course, people listening to the podcast, including this one.
Would you kindly comment on the short-term and long-term side effects of taking meds, both synthetic and naturopathic? I’m told they can cause nutrient deficiencies and other issues.
I wish I knew which type. I assume you’re talking about thyroid hormone, but I’m not sure. Thyroid hormone replacement shouldn’t cause nutrient deficiencies. To me, it’s not a typical medication. It’s more of a hormone replacement. It is synthetic. If you take levothyroxine, for example, Synthroid. Time and place for thyroid hormone replacement.
Antithyroid medication can potentially affect the gut negatively, which can potentially lead to nutrient deficiencies.
Really short-term and long-term side effects. With thyroid hormone replacement, there is some concern about bone density. If someone takes it long-term, it could negatively affect bone density. We really want to monitor the thyroid hormone levels and maybe do a bone density scan, like a DEXA scan.
Some endocrinologists are concerned about long-term antithyroid medication use because of the effects on the liver. I’m not supporting long-term use. I’m not saying that is ideal. Ideally, you want to restore your health, so you don’t need to take any thyroid medication. I do have a podcast episode where I mention studies showing that low dose antithyroid medication, especially methimazole, 5-10mg, can safely be taken by many people for 10-15 years or even longer without consequences, as far as damaging liver or kidneys.
Side effects are common. If someone is tolerating the medication well, in this case, antithyroid medication, everything is risk versus benefits. I’d rather someone take a low dose of antithyroid medication for a number of years than to get radioactive iodine or thyroid surgery.
The #1 goal with either hypothyroidism or hyperthyroidism would be to restore your health and get to the point where you don’t need the medication. With hyperthyroidism, most people I work with reach that point. With hypothyroidism, I do get people to the point where they don’t need to take thyroid hormone replacement, but not everybody. Some people end up staying on it.
It’s a little bit different. With the damage to the thyroid gland, if someone has extensive damage, it could take a long time for that to heal. As I mentioned earlier, things like laser therapy or potentially red-light therapy might help speed up the process.
My question is a small one. Is it true that having my tonsils taken out when I was 11 is a reason why I’ve had hypothyroidism since my early 30s? We don’t have it in our family.
I don’t know if you have Hashimoto’s. Tonsils are important for the immune system. There is no way to know 100% if that is the main factor or a contributing factor, but it could be.
If it’s not autoimmune, my guess would be no. I’m not 100% sure. I honestly haven’t done research on people who have had a tonsillectomy and then those who have developed hypothyroidism/Hashimoto’s. Since I know it is very important for the immune system, it would make sense. It would be interesting. I haven’t looked into if there is any research on getting tonsillectomies and if that increases susceptibility of Hashimoto’s and other autoimmune conditions. That’s something I might have to do a little bit of research on. It is interesting.
I have hyperparathyroidism. I don’t know if you treat that.
I brought this up here to let this person and others know that, even though hyperparathyroidism has the word “thyroid” in it, so someone who can help with thyroid conditions should be able to help with hyperparathyroid or hypoparathyroid issues.
The parathyroid gland and the thyroid gland are different. If someone has hyperparathyroidism, many times, it’s caused by an adenoma, which is a benign tumor. I have had a few patients try some natural methods. I have not seen anyone successfully shrink or get rid of the adenoma naturally. Maybe it can be done. I just haven’t seen it. If it’s caused by other issues, I’m just not the person to work with that.
I did have on the podcast Dr. Divya Boone, who spoke about it. Even though she is open to functional medicine, she also, just to be transparent, is a parathyroid surgeon. I had her on the podcast because a few other functional medicine practitioners had her on to explain what hyperparathyroidism is.
Even though she is open to functional medicine, there just doesn’t seem to be a functional medicine approach that I’m aware of that has worked. If anybody listening has reversed primary hyperparathyroidism naturally, where you or someone you know had an adenoma, definitely let me know.
I am always cold, fatigued, and my hair has thinned immensely. These are some of what is/has been happening in my body. Are these thyroid-related? If so, is it too late for a fix?
I would never say it’s too late for a fix. Coldness, fatigue, hair loss, it sounds like thyroid. The way to know is to test TSH, free T4, free T3. If you could do the antibodies as well, and if you want to add reverse T3. At the very least, TSH, free T4, free T3, and see.
The blood test might be within the lab range, but the question is are they within the optimal range? If they’re not within the optimal range, then you still very well might have a thyroid issue, even if the labs look good. If TSH is 3 or 4, for example, which is in most lab ranges, you probably have something going on there. You wouldn’t want to rely on TSH, so that’s ideally why you also want to look at T4 and T3. In this situation, honestly, TSH will be above optimal in most cases if someone has a thyroid issue. You want the complete picture, looking at the thyroid hormones as well.
How can I get thyroid nodules to shrink or disappear without surgery or radiation?
I will refer you to my episodes where I talk about thyroid nodules. If you search “thyroid nodules” on my website, you’ll see them. I’ve had solo episodes. A recent interview with Dr. Angela Mazza.
The goal is to try to address the cause of the problem. Thyroid nodules could be insulin resistant, so you could do a test for hemoglobin A1C and fasting insulin. It could be a problem with estrogen metabolism, which dried urine testing can look into. Inflammation as well. On the podcast with Dr. Mazza, she mentioned inflammation. A lot of things can cause inflammation. Work with a practitioner.
I will say there is also radiofrequency ablation (RFA), which is not radioactive iodine. It’s using radio frequencies to shrink. I mentioned goiter early on, but it’s more commonly used for nodules. It’s not addressing the cause of the problem, but if someone has large nodules, and the medical doctor is recommending surgery, RFA is something to look into.
I had a partial thyroidectomy done in 2004. I wasn’t told I should see an endocrinologist, or I may need to support my thyroid after the surgery. A couple of years later, through routine bloodwork, I discovered my thyroid was severely underactive. Over the years, I have worked with several doctors, and it seems not one of them understood how to give me the correct dosage of thyroid supporting meds. I have avoided prescriptive meds and have been using natural bovine glandulars. I have also been told that if you still have part of your thyroid, it would compensate, and you wouldn’t need to support it with anything. I have had five instances of severe hair loss in the past few years, all due to not supporting my thyroid sufficiently. I don’t understand why I continue to need more supplementation. Does the thyroid actually learn to compensate for the missing half? If so, when? What causes the thyroid to continue to need more and more support over time?
Some people with a partial thyroidectomy don’t need thyroid hormone, but some people do. There is no guarantee that you get a partial thyroidectomy, and the thyroid gland will compensate. Some people certainly do need thyroid hormone replacement.
As far as why people need more support, it’s especially common with Hashimoto’s as we see more damage to the thyroid gland taking place, assuming we are not doing anything to help improve the immune system, to address the autoimmune component of Hashimoto’s. Over time, more and more damage will take place to the thyroid gland, and the person will need to increase the dose of thyroid hormone.
Why do I overheat or sweat when doing something as simple as walking through the grocery store? It’s not a hot flash. What can I do to treat it?
I’m not sure of your situation. If you have hyperthyroidism, that can cause heat intolerance and sweating. You would want to balance the thyroid hormones. If you have lower estrogen levels, even though those many times will cause hot flashes, that’s something to look into. Imbalances of the parasympathetic nervous system, which is not as easy to evaluate, work with a practitioner.
I don’t know what type of thyroid condition you have. If you have an autoimmune thyroid condition. Stress, adrenals can put someone in fight or flight and dysregulate the nervous system. It could also be a factor.
As of recording this, there is an episode I have coming up on nervous system dysregulation and how to regulate the nervous system. It will be coming out a few weeks after this one comes out. I do have some other episodes but not really ones that focus on regulating the nervous system. At least I don’t think I do. I have Dr. Amie Apigian, who spoke about the biology of trauma. Some of that relates to that. You can certainly listen to that, but there will be another episode you might want to check out.
Does someone who had their thyroid removed still have thyroid antibodies? Can the antibodies continue to cause harm once the thyroid is removed?
Removing the thyroid does nothing for the autoimmune component of Graves’ or Hashimoto’s. The antibodies themselves aren’t doing the damage, but the concern is if you remove the thyroid gland and don’t do anything to improve the immune system health, then over time, you can develop other autoimmune conditions. The concern is not necessarily with the current thyroid antibodies, but it’s that you still have autoimmunity. If you haven’t done anything to heal your gut, to improve your overall immune system health, then you might develop other autoimmune conditions in the future.
I’m wondering about traditional homemade sourdough bread. Since it’s leavened with Lactobacillus instead of yeast, I’ve learned that in the fermentation process, it becomes 90% gluten-free. Would this be a safe bread alternative occasionally if it’s made with clean ingredients?
I get this question a lot about sourdough bread or healthier forms of bread like Ezekiel bread, like ancient grains. 90% for many people is not enough, certainly not for Celiac patients, but even for people who don’t have Celiac. On a wellness basis, it might be different.
When someone is healing, same thing with the question related to the raw A2 dairy. Someone might be okay with this, but if someone is eating sourdough bread for three months and doing everything else right, and they are not healing, I am going to look at the sourdough bread and wonder if that’s the reason. Maybe it’s not. In this situation, I would still tell the person to take a break. I tell them to take a break from the beginning.
I know it might not be easy, but I want the person to progress as quickly as possible. I can’t say with confidence that this would be a safe bread alternative, especially if someone is healing, even though you mentioned it’s occasional and made with clean ingredients. On a wellness basis, even then, no guarantee. I feel more comfortable when someone is in a healthier state.
Why don’t any of the thyroid medications I am prescribed work? They start out good, but after a while, they turn and work almost in an opposite way. I heard that there could be a missing piece, T2 or T3 or maybe both. I’m always tired, no energy.
The doctor you go to gave you typical thyroid medications, meaning not a natural one. It sounds like you’re on levothyroxine, which is just T4. You might have an issue converting T4 to T3.
T2 is different. I know there are now T2 supplements, but the first thing I would say is if you haven’t been getting a full thyroid panel, not just TSH and T4, but also T3, maybe even reverse T3, and see if you have issues converting T4 to T3. If that’s the case, you might just need to either talk with your doctor about recommending T3, something like Cytomel. You might have to work with another practitioner to try to get on NP Thyroid or Armour or a different type of desiccated thyroid hormone. That very well could be the reason.
Also, keep in mind that not everything is related to the thyroid, too. There are adrenal issues. The adrenals, the gut. There are so many different imbalances one can have. You don’t just want to focus on the thyroid. For everyone here, you don’t just want to take thyroid hormone replacement or take antithyroid medication. You want to do things to improve your health. That’s what this podcast is all about.
That is it for this episode for questions related to thyroid health. In the next episode, I will be discussing questions related to hyperthyroidism and Graves’. There were some questions here that can also benefit people with hyperthyroidism, but the next episode should be exclusive to those with hyperthyroidism. Not just Graves’ but other types of hyperthyroidism, too. If you have any type of hyperthyroid condition, tune in. if you have hypothyroidism, you might still benefit from some of the questions and answers.
With that being said, thank you so much for listening to this episode. Thanks to those who submitted your questions. I apologize that I couldn’t get to all questions. There were so many questions, which is great. It’s amazing that so many people emailed questions. I could have a two-hour or three-hour episode, but to me, that’s too long. Even over an hour is on the longer side. That’s why I’m having two episodes here. I could have four episodes or six episodes, but I think that’s too extreme. Also, some questions would not have benefited everybody. Some were really long. Even some of these that I read were a little bit long.
Anyway, thank you for submitting your questions. Thanks for listening. Look forward to catching you in the next episode.