When I was first attempting to uncover the root cause of my Hashimoto’s, I came across research by Dr. Alessio Fasano, a world-renowned gastroenterologist, relating to what causes the body to start attacking the thyroid gland in the first place. One of the key points of his research was that three things needed to be present to cause – and sustain– an autoimmune disease such as Hashimoto’s:
- The genetic predisposition
- Triggers that “turn on” the genes
- Intestinal permeability (“leaky gut”)
When we remove one of these, we can prevent or stop the progression of autoimmune disease.
Obviously, we can’t change our genes, but we can address our triggers and intestinal permeability!
I always come back to this simple– yet powerful – concept whenever I am helping someone discover their root causes. It illustrates how each and every one of us suffering from thyroid symptoms has the ability to get better. Our genes are not our destiny. I continue to find that incredibly empowering. And it is supported by science (which is important for a researcher like me).
The issues of triggers and intestinal permeability are the focus of much of my books, Hashimoto’s Root Causeand Hashimoto’s Protocol. In my book, I walk through the steps that each person needs to take to remove the most common Hashimoto’s triggers, such as food sensitivities (gluten and dairy are the top culprits), chronic infections, stress, and environmental toxins. I also detail the importance of good liver support and take readers through steps to heal their nutrient deficiencies and intestinal permeability issues.
Many of those who have followed my protocols have reported success with improving their health. For example, in my 2015 survey of 2,232 people having Hashimoto’s, 86 percent of people surveyed who had gone gluten free reported improvements in their digestive symptoms! While most people will see substantial improvements as they identify and remove their triggers, some people may still struggle and need to dig deeper to determine additional “hidden” triggers for them.
After working with thousands of clients, I have found that one common “hidden” trigger that may elude many people is the other medications they may take for non-thyroid conditions.
Identifying Your Triggers, an Important Initial Step to Feeling Better
When I was first diagnosed with Hashimoto’s, I realized that my taking artificial hormones in the form of birth control was one of my hidden triggers. Estrogen found in birth control pills can potentially exacerbate thyroid dysfunction, so I had to kick the birth control habit and find another solution. (You can read about that healthier solutionif you are interested.)
As a pharmacist. I was already well aware that many medications produced drug interactions with externally taken thyroid hormones. Given the importance of dosing when it comes to the effectiveness of thyroid hormone treatment, even slight alterations in the absorption of medications could impact the effect of thyroid hormones!
As a medication safety pharmacist, I was also hyper-focused on any and all emerging research relating to how adverse drug reactions directly harm the thyroid in other ways.
I came across a few surprises. Along with identifying a list of commonly prescribed medications that caused problems such as hidden thyroid triggers, I learned about the significant potential for ill effects that fluoride has on thyroid health (as well as the fact that many seemingly innocent medications contain fluoride!).
So, as you look to find your hidden triggers, you need to ask yourself if the medications you take could be a trigger for your thyroid dysfunction.
Remember Dr. Fasano’s concept: if you can remove the triggers for your thyroid dysfunction, you can heal yourself.
How Other Diseases and Medications Affect Your Thyroid
A good place to begin is to think about what other health issues you may have and whether you take medication for these issues or not.
This is important for a number of reasons. First, many other disorders, especially gastrointestinal disorders (such as undiagnosed celiac disease, atrophic gastritis, lactose intolerance, malabsorption in the small intestine, and Helicobacter pylori infections) may impede the absorption of thyroid hormones (such as levothyroxine) you may have been prescribed.
Second, the medications you may be taking for these additional health issues could themselves affect the absorption of your thyroid hormones. Thyroid medications are referred to as “goldilocks” hormones, which mean that they have a narrow therapeutic index. They are dosed in micrograms (1/1000th of a milligram), and very slight changes in doses (such as what happens if absorption is affected) can lead to symptoms due to under-treatment or over-treatment.
Third, along with affecting hormone absorption, medications for other health conditions beyond your thyroid may have a direct effect on the health of your thyroid in other ways. Some have been found to destroy thyroid cells and tissue, impact natural thyroid hormone production and even affect the immune processes of the thyroid gland. Other medications have been found to trigger Hashimoto’s.
Some medications may also contain fillers that you may have food sensitivities to (such as lactose or perhaps gluten), or may contain chemicals that can directly impact your thyroid.
Finally, thyroid medications can in turn impact the effectiveness and toxicity profile of other medications. This is one reason that, as a pharmacist, I always recommend you fill all of your prescriptions at the same pharmacy so your pharmacist can do a check of possible drug interactions every time you fill a new prescription.
To learn more about common drug interactions that can lead to impaired thyroid hormone absorption, download my free guide below!
The Top 9 Drugs Affecting Thyroid Function
Lithium is still a widely used drug in internal medicine and psychiatry, and has been used for decades as a mood stabilizer for those with bipolar disorder, major depression and suicidal ideation.
Lithium is prescribed in the U.S. as a generic drug (Lithium Citrate or Lithium Carbonate) or under the brand names Lithobid, Eskalith and Lithate. Lithium Citrate and Lithium Carbonate have been approved by the U.S. Food and Drug Administration (FDA). Lithium Orotate has not gained FDA approval, but can be found marketed online.
Note that some drinking water may also include small amounts of lithium. One 2015 study found that lithium exposure through drinking water impaired thyroid function in test subjects (pregnant women in this case). This is yet another reason I attest to using a water filter. (You can see the one I recommend below in the section on fluoride, which is another thing you’ll want to filter out!)
So why is Lithium a problem? Lithium is accumulated at highly concentrated levels in the thyroid gland (at 3 to 4-fold higher concentrations as compared to its plasma levels). It has been found to inhibit synthesis and release of thyroid hormones, and may lead to increased destruction of thyroid cells. Lithium therapy side effects include goiters and hypothyroidism. It may also induce an increased risk of thyroid autoimmunity in susceptible individuals, as well as potentially lead to increased destruction of thyroid cells.
In research published in 2000 summarizing available findings, hypothyroidism and subclinical hypothyroidism had been reported in 5 to 20 percent and as high as 50 percent of people taking lithium carbonate.
Other studies have also validated these and other thyroid effects. In a 2014 study, lithium treatment in adolescents was associated with a significant increase in blood TSH levels.
Considerations for Taking Lithium
Should you consider beginning Lithium treatment for depression? First, talk with your doctor about whether your depression could be caused by issues with your thyroid! Depression and anxiety are common thyroid symptoms. I have found that after fatigue and weight gain, mood alterations such as these are the most common symptoms in people with Hashimoto’s.
Hashimoto’s causes a breakdown of the thyroid gland, which can cause thyroid hormones to be dumped into the bloodstream, leading to transient hyperthyroidism. Symptoms of agitation, anxiety, and even psychosis can occur. Some patients have been misdiagnosed (even hospitalized) with “bipolar disorder” or “schizophrenia” when in fact they were suffering from thyroid imbalances.
While I didn’t suffer from bipolar disorder, I battled with depression before my Hashimoto’s diagnosis. It is a very real concern, and you can read more about it here.
Progressive psychiatrists will test patients that present with new onset depression, anxiety and other mental health conditions for thyroid disorders and may be open to initially prescribing thyroid medication.
Even if their recommendation still calls for Lithium, it is important that you obtain baseline information on thyroid function with a full thyroid blood test panel(TSH, TPO antibodies, Thyroglobulin antibodies, and TSH receptor antibodies) and that you are checked on a regular basis once you begin Lithium treatment. You may also want to use thyroid ultrasonography to evaluate goiter development.
Nutritional lithium known as lithium orotate, when used in small doses of 5-40 mg, may be a safer option that can provide mood stabilizing benefits for people with thyroid disorders. I recommend reading Nutritional Lithium – A Cinderella Story: The Untold Tale of a Mineral That Transforms Lives and Heals the Brain for more information about nutritional lithium.
You may want to discuss this research with your physician to ensure they are aware of the information.
Amiodarone is a potent anti-arrhythmic medication commonly used for heart disease conditions such as atrial fibrillation and is one of the most commonly prescribed anti-arrhythmic medications in North America.
It is estimated that atrial fibrillation will affect more than 10 million patients in the United States by 2050. Amiodarone is used to help keep the heart beating normally in patients who have this condition.
Because of the drug’s many known side effects, it is only used when other medications have failed in treating this type of life-threatening disorder. The drug is an iodine-rich compound that accumulates in several organs, including the lungs and thyroid. In the lungs, use of amiodarone has been associated with pulmonary toxicity.It has also been shown to have a profound impact on thyroid physiology and dysfunction.
Due to its iodine-rich nature, amiodarone can cause iodine overload up to 50-100 times the optimal daily intake. No, that isn’t a typo!
Amiodarone-induced thyroid disease has been estimated to occur in 2 to 24 percent of people who take it. The ill effects on the thyroid range from abnormal thyroid function test findings to overt thyroid dysfunction, with hypothyroidism resulting more commonly than hyperthyroidism. Both conditions can develop in normal thyroid glands or in glands with preexisting abnormalities.
Hypothyroidism is reported in 6 to 10 percent of patients receiving amiodarone. Even when amiodarone medication is stopped, levothyroxine replacement is often still necessary.
Amiodarone-induced thyrotoxicosis (a form of hyperthyroidism) develops in 3 percent of amiodarone-treated patients in North America. For those living in iodine-depleted areas, the incidence is even higher (10 percent).
Two types of amiodarone-induced hyperthyroidism have been identified. Type 1 is a Graves disease-like hyperthyroidism characterized by the presence of antithyroid antibodies. Type 2 produces no antithyroid antibodies, but creates a direct toxic effect on the gland, causing it to dump thyroid hormone into circulation.
Considerations for Taking Amiodarone
Baseline thyroid function tests should be performed in all cardiac patients to exclude underlying thyroid gland dysfunction that may predispose an individual to hypo- or hyperthyroidism after amiodarone therapy is started. Subsequent thyroid testing should be done, including ongoing follow-ups to monitor serum TSH concentrations and thyroid antibodies.
Note that there is a replacement drug, Dronedarone (brand name is Multaq), that has been approved as an anti-arrhythmic drug and appears to share the pharmacological actions of amiodarone without having the iodine component that causes the multiple organ toxicities.
However, this drug is being reviewed by the FDA relating to reports that it increases the risk of cardiovascular death and heart failure in patients with permanent atrial fibrillation. It may be something you want to discuss with your doctor.
Fluoride is found in many communities in public water (as fluoridation to promote fewer cavities), is in some toothpaste, is often used in dental treatments, and is found in bottled beverages and a large variety of medications as a filler.
According to the Center for Disease Control’s 2014 analysis on fluoridation, 74.4 percent of the US population getting their water through community water systems was receiving fluoridated water.
Given all of that, you might be surprised to learn that fluoride is toxic to thyroid function!
Fluoride was actually used to treat hyperthyroidism up until the 1950’s, prior to the development of other thyroid-suppressing medications. It is effective as a thyroid suppressor at doses of 0.9-4.2 mg per day for hyperthyroidism.
If most adults in fluoridated communities are ingesting between 1.6 and 6.6 mg of fluoride per day from their drinking water, that’s more than enough to suppress their thyroid function!
You can read an article I previously wrote on fluoride and your thyroid health here, which contains a good deal of research references.
There are several additional studies focused on fluoride’s effect on the thyroid. In one very large observational study in England, researchers looked at the 2012 levels of fluoride in the community drinking water supplies throughout the country. They then evaluated the prevalence of underactive thyroid in regions both having fluoridation as well as those that did not have fluoridation. Reported thyroid cases were those diagnosed by a large population of family doctors throughout the country. Areas with water fluoridation were linked to a 30 percent higher rate of underactive thyroid.
In another study focused on the effects of fluoridation on the thyroids of children, it was observed that high fluoride exposure can cause functional abnormalities of the thyroid. Researchers found that the TSH output from the pituitary gland is inhibited by fluoride, reducing thyroid hormone output from the glands.
Further research indicates that fluoride may act as a trigger in inducing thyroid cell death and inflammation. Its usage can lead to the development of thyroiditis and autoimmune thyroiditis.
With my clients and readers, I have seen some people report improvement in thyroid symptoms and thyroid function tests following the removal of fluoride from their lifestyle.
Fluoride-containing medications include antacids, appetite suppressants, anti-anxiety medications, antibiotics, antidepressants, antihistamines, cholesterol-lowering medications, anti-malarial medications, anesthetics, chemotherapy medications, arthritis medications, psychotropic medications, antifungals and steroids.
Some of the most commonly used medications that contain fluoride include:
- Prevacid®: used for acid reflux
- Prozac®, Lexapro®, Celexa®, Paxil®: used for anxiety, depression, or OCD
- Diflucan®: an antifungal used for yeast infections
- Cipro®, Levaquin®, Avelox®: Fluoroquinolone antibiotics used for UTIs and other infections
- Celebrex®: used for pain
- Lipitor®, Zetia®: used to lower cholesterol
You can check this site for afull list of medications containing fluoride.
Considerations Relating to Fluoride
To remove fluoride, you have to know where to find it!
It can be found in some medications and supplements, canned foods, chewing tobacco, toothpaste, teas (especially the black and red varieties), dental treatments, and water (in fluoridated communities). Bottled water isn’t a safe go-to either since some contain fluoride (seehttp://fluoridealert.org/content/bottled-water/ for more information).
The easiest thing you can do is to start with the water you drink (that should be the bulk of the daily fluoride exposure you receive), especially should it be fluoridated. You can remove fluoride from water using reverse osmosis filtration systems or activated alumina defluoridation filters. Most other filters do not remove fluoride. My go-to filter is the AquaTru Reverse Osmosis Filter. You can read more details about cost-effective reverse osmosis filters in my article on dental triggers for Hashimoto’s. (This same article, by the way, provides a great overview of other triggers found in your mouth and dentist’s office!)
You can also utilize supplements to help recover from long term fluoride use. A recent study done with rats has shown that taurine, a major constituent of bile, can partially alleviate thyroid dysfunction caused by fluoride! Taurine and other bile boosting ingredients can be found in theRootcology Liver & Gallbladder Support.
4. Birth Control or Hormone Replacement Therapy Using Oral Estrogens
Oral estrogens, such as those taken for birth control or hormone replacement therapy, cause an increase in thyroxine-binding globulin (TBG). TBG binds thyroid hormone. More circulating TBG leads to lower levels of free thyroid hormone available for use by the body.
Women starting estrogen may find an elevation of their TSH level, and dose adjustments to their thyroid hormone medication may be necessary.
Oral contraceptives can also cause an excess of estrogen referred to as estrogen dominance, which, along with mood swings, hormone imbalances and weight gain, can increase inflammation and worsen hypothyroid symptoms. It can even trigger autoimmune conditions. You can read more about how hormone imbalances can be a trigger for Hashimoto’s here.
Birth control pills can also deplete selenium, zinc and the amino acid tyrosine which are all necessary for proper thyroid function. Check out more about this in the book Drug Muggersby Suzy Cohen, RPh, America’s Pharmacist.
Another trigger relating to some oral contraceptives is the fillers that can be found in the pills. For example, many contain lactose. This may be an additional issue for women with Hashimoto’s (who often present with dairy and gluten intolerance issues). It was definitely a hidden trigger for me!
Oral contraceptives have many other health considerations beyond your thyroid. Other health issues such as increased risk of blood clots and strokes, osteoporosis, changes to our natural flora (allowing yeast and other pathogenic organisms to flourish), and more. You should discuss these issues, along with your thyroid concerns, with your physician.
Considerations for Oral Contraceptives
As I mentioned earlier, birth control pills were one of my hidden triggers, and I also wanted to find a healthier– yet highly reliable– option. I love the Lady-Comp and Daisy Fertility Monitors. You can read more about them as well as the Fertility Awareness Method, if you are interested.
Of course, there may be medical reasons why a woman may need to continue taking oral contraceptives. In that case, it is important that you have regular monitoring of your thyroid function and medication dosage, and it is even more important to supplement with probiotics, magnesium, zinc, B vitamins and Vitamin C.
5. Proton Pump Inhibitors (PPIs)
These days, many people are taking Proton Pump Inhibitors (PPI therapy) to address acid reflux (gastroesophageal reflux disease or GERD), peptic ulcers and indigestion. They are the most common “acid blockers”. In 2008, Americans spent $14.1 billion on these types of drugs. In 2014, Americans filled more than 170 million prescriptions for acid blockers.
Some of the more common generic and brand names of PPIs are:
- omeprazole (Prilosec, Prilosec OTC)
- lansoprazole (Prevacid, Prevacid IV, Prevacid 24-Hour)
- esomeprazole (Nexium, Nexium IV, Nexium 24 HR)
- dexlansoprazole (Dexilant, Dexilant Solutab)
- rabeprazole (Aciphex, Aciphex Sprinkle)
- pantoprazole (Protonix)
- esomeprazole magnesium/naproxen (Vimovo)
- omeprazole/sodium bicarbonate (Zegerid, Zegerid OTC)
When I was initially symptomatic, I had incredible acid reflux issues. I had tried a variety of the popular proton pump inhibitors (Prilosec, Aciphex and Nexium), Pepcid, Tums and Pepto Bismol… nothing worked. I drank gallons of milk and bottles of Mylanta trying to soothe the burning, choking sensation. I avoided all sorts of “acidic” foods such as oranges, tomato sauces and red wine.
And then I found my trigger- something I had been consuming for years without knowing it was the root of my digestive troubles. Finally, I had an IgA food intolerance test that showed me what the culprit of my acid reflux issues was: dairy!
After giving up dairy, I no longer had acid reflux symptoms and no longer had to take any of my acid suppressing medications. It was only then that I learned about the many negatives associated with thyroid health and taking PPIs and similar over-the-counter medications.
I also learned that acid reflux symptoms are very common in people having Hashimoto’s.
Even more important, my research pointed out that the issue for people having Hashimoto’s wasn’t their having too much acid! The reality is that most people with Hashimoto’s have too little or even no stomach acid. Low stomach acid can have the same symptoms as acid reflux.
And guess what? Acid-suppressing medications made the symptoms worse and did nothing to remove the underlying root cause (in my case, my food sensitivity to dairy).
The bulk of evidence suggests that PPIs reduce levothyroxine absorption.
Research has found that patients with impaired gastric secretion required a higher dosage of thyroxine.
Other research showed that patients with hypothyroidism and normal TSH values during levothyroxine replacement therapy may need additional thyroid function testing after treatment with PPIs and may need adjustment of their levothyroxine dose.
Considerations Relating to PPIs and Other Acid Blockers
With clients and readers, and in my research, I have consistently found medications and supplements that suppress stomach acid may cause impaired absorption of thyroid hormones, and that includes the above proton pump inhibitors, as well as antacids, calcium, magnesium-aluminum and iron. For that reason, I always recommend spacing out calcium, iron and magnesium supplements by at least 4 hours from thyroid medications.
I also recommend a careful re-evaluation of the use of acid-suppressing medications in everyone with Hashimoto’s and hypothyroidism. I suggest looking for the actual trigger for the acid reflux symptoms, which is often a food sensitivity or infection. It’s especially important to look at common food sensitivities such as dairy and gluten to see if that resolves the acid problem. If not, I have found the Alletess IgG Food Sensitivity Test to be highly reliable for identifying acid reflux inducing foods. One can test for H-pylori which can also cause acid reflux symptoms and be a hidden trigger for you.
Low stomach acid, again, is common in people having Hashimoto’s. Plus, having low or no stomach acid puts people at a greater risk for many health issues such as contracting parasites from our food, developing food sensitivities, developing small intestinal bacterial overgrowth (SIBO), and developing nutrient depletions.
Betaine with Pepsin can also be helpful to re-acidify gastric pH.
In my May 2015 survey of 2232 people with Hashimoto’s, out of 627 people who took Betaine HCl and Pepsin, 59 percent of people said that it made them feel better. To learn more about Betaine with Pepsin and other interventions that can help you if you have acid reflux or other digestive issues, you can start with this article.
Some of my clients and readers with low stomach acid have also found that taking thyroid medications with hot lemon water (the juice of one lemon in a glass of water) or with apple cider vinegar (one teaspoon per 8 oz. glass of water) can help provide enough acidity to aid with the absorption of their thyroid hormones.
This medication is used to treat a wide variety of cancers (including melanoma, leukemia and AIDS-related sarcoma) and is also a treatment for a number of viral infections (chronic hepatitis C, chronic hepatitis B, condylomata acuminate).
Interferons are thought to work by boosting the body’s immune system response to reduce either the growth of cancer cells or help the body fight off virus infections. They do not kill cancerous or viral cells, but regulate the action of specific genes that control the production of cellular proteins that affect cell growth. They “interfere”, if you will, with the targeted (dangerous) cells.
Interferons (IFN) used therapeutically are manufactured using recombinant DNA technology and come in a variety of classes (alpha/α, beta/β and gamma/γ). All of these classes have antiviral properties, and there is a wide assortment of generics and brands available. The different classes are used for varied disease treatments and have their own known benefits as well as side effects.
IFN-α (alpha) forms are widely used in the treatment of chronic hepatitis C virus (HCV) infections and some forms of cancer. IFN-β (beta) treatment has been used primarily to treat multiple sclerosis (MS). IFN-γ (gamma) has been approved for use in a rare congenital disorder, chronic granulomatous disease.
By far, one of the most frequent applications of interferon is against chronic HCV infections, for which IFN-α has been an approved treatment since 1991. As per the World Health Organization (WHO), nearly 3 percent of the global population suffers from Hepatitis C Virus (HCV) infection.
The importance of interferon therapy for this disorder is emphasized by the fact that 1.5–2.2 percent of Western populations are positive for HCV, and HCV infection is a potentially life-threatening disease. 75 percent of affected patients with acute infection develop chronic disease with a high risk of cirrhosis and hepatocellular carcinoma.
Common brand names for IFN-α medications are Alferon N, Intron A, Pegasys, PegIntron, Sylatron and Roferon-A.
While providing beneficial results in most cases, thyroid disease has been primarily reported due to treatment based on Interferon Alfa A (IFN-α).
The prevalence of thyroid abnormalities during interferon therapy ranges from 2.5 to 20 percent.
Interferon-induced thyroiditis (IIT) is a major clinical problem for patients who receive IFN therapy. Hypothyroidism is more common (40-50 percent of patients) than hyperthyroidism (10-30 percent of patients).
Considerations if Taking Interferon
Always discuss available research like this with your doctor. He/she should be monitoring your thyroid levels while on interferon, regardless of whether or not you are currently taking thyroid hormone medication. Symptoms of thyroid dysfunction may be absent or occur as early as 6 to 8 weeks after starting therapy, or be delayed until after 6 to 23 months of receiving therapy.
For many patients taking interferon, thyroid dysfunction seems to be transient and has been shown to resolve itself after patients stop interferon therapy. If you weren’t already on levothyroxine treatment, you may need to be in order to alleviate hypothyroid symptoms.
This is a brand name medication which was used for serious skin conditions such as cystic acne. The generic drug is isotretinoin, which is sometimes also referred to as 13-cis retinoic acid. It is a naturally occurring derivative of vitamin A. Accutane was marketed to reduce the amount of oil released by the oil glands in your skin, and that is how the generic works as well. There are many known side effects, some quite serious such as birth defects (if taken by pregnant women), mood disorders, digestive issues, and more.
In June 2009, Roche Pharmaceuticals pulled Accutane from the US market due to both increased competition from generics as well as increasing liability from personal-injury lawsuits. The product had been the subject of many claims relating to irritable bowel disease as a side effect.
Today, a variety of generics and brands of isotretinoin can be purchased, either through prescription or online. Online, vendors still market “Accutane” and Accutane look-alikes.
Some brands available today include: Absorica, Myorisan, Amnesteem, Claravis, Roaccutane and Zenatane.
While there isn’t a lot of specific research on isotretinoin’s potential effects on the thyroid, there have been enough questions raised – and a number of documented case studies – about potential side effects that you should at least be aware of.
Additionally, please do your research on ALL of the ill effects of this drug! It’s important for everyone but especially for women who may become pregnant. In the US, there is in fact an FDA-mandated program called iPLEDGE where dermatologists who prescribe isotretinoin must register individual patients using the prescription. This is primarily focused on women with childbearing potential due to the significant risks involved.
Much of the research that does exist on isotretinoin has been focused on other side effects such as birth defects, depression, etc. There have also been a few studies focused on the medication’s effects relating to autoimmune diseases, including thyroiditis, as well as diabetes and autoimmune hepatitis, in genetically-susceptible individuals.
Those few studies have found that isotretinoin treatment caused significant increases in TSH levels, but further evaluation was deemed necessary relating to whether the drug may play a role in triggering autoimmunities, such as Hashimoto’s, in genetically susceptible individuals.
Considerations Regarding Accutane
As already mentioned, there are numerous ill effects associated with use of isotretinoin. Impact to your thyroid should be considered one potential issue, but frankly, there are so many others that you should avoid this drug in most cases.
My suggestion for acne issues starts with removing triggers such as food sensitivities, toxins, and endocrine disruptors, and improving gut health. In my book, Hashimoto’s Protocol, I go through a step-by-step approach to doing this, prioritized in a such a way that most people start to feel better fairly quickly. Many people will see improvements in their skin by implementing these lifestyle changes.
If you have Hashimoto’s, you need to be even more careful than other people in regards to “chemicals” you apply to your body or take into your body. I wrote an article on beauty products, focusing specifically on how detrimental some can be to your health.
If you’ve been doing any research at all on thyroid disease, you know that iodine is a critical nutrient for thyroid health. Iodine deficiency in some parts of the world is the primary reason for hypothyroidism.
Iodine excess, on the other hand, can be a risk factor for developing Hashimoto’s in people who are genetically predisposed to Hashimoto’s and who may have certain co-occurring vulnerabilities like a selenium deficiency.
Another vulnerability could be intestinal permeability (leaky gut). Studies have shown that excess iodine causes thyroid injury by generating reactive oxygen species, which lead to premature damage and programmed cell death in thyroid tissues. These iodine-overloaded cells can then turn on the autoimmune process in a person with the right genetic predisposition and intestinal permeability.
I have seen many people harmed by a high dosage of iodine. Yes, they may initially feel great. But then they feel worse… much worse in most cases.
Taking a high dose of iodine can exacerbate Hashimoto’s and accelerate thyroid cell destruction. The American Thyroid Association cautions against using doses of more than 500 mcg per day in the general public and noted that doses above 1100 mcg may cause thyroid dysfunction. These warnings are for the general population, but studies have found that people with Hashimoto’s may be sensitive to even smaller doses.
In some cases, a low iodine diet has been helpful in reducing the autoimmune attack on the thyroid gland and in normalizing thyroid function in people with iodine-induced Hashimoto’s. For more information about the low iodine approach, please see my first book Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.
Considerations for Taking Iodine
Iodine is a complicated topic, so please refer to an earlier article I wrote, which was focused on iodine. This article includes more research information, as well as the results of my Root Cause Rebels survey on using iodine versus using selenium. Find out which intervention had the greatest effect. You might be surprised!
To summarize… although iodine serves as fuel for our thyroid and is very important in iodine deficiency induced hypothyroidism, Hashimoto’s is a different mechanism.
Adding iodine is like pouring gas into an engine that’s on fire… that’s essentially what’s happening in Hashimoto’s. Adding iodine to the mix before putting out the fire and fixing the engine may result in further damage to the thyroid. In those with a predisposition to autoimmunity, this has been documented time and time again, in both animal and human studies. My approach is, let’s fix the engine first (usually a gut issue), and then add the fuel once we know that the engine is no longer on fire. Please read the article linked above and also check out my book, Hashimoto’s: Root Cause. I have an entire chapter on the iodine controversy that references numerous studies.
One of my friends, a functional medicine nutritionist, noticed that for some women, the popular wrinkle reducing cosmetic procedure “botox” can bring on or exacerbate Hashimoto’s.
Botox is a brand name for the Botulinum toxin. Note the word toxin in its name! The Botulinum toxin (type A is for treating frown lines) was approved by the FDA in 2002. Since then, its injection has become one of the most common cosmetic procedures. But, there have been many concerns raised about potential side-effects.
Botulinum toxins are among the most toxic poisons known to humans, with a lethal dose of approximately 1 ng per kilogram body weight. There are seven serologically distinct types of botulinum toxins. Botulinum toxin A (used in cosmetics treatments) is the most potent serotype, with a toxicity one million-fold higher than cobra toxin and far higher than cyanide!
Yet, we somehow decided it was a good idea to inject it into our skin for strictly cosmetic purposes.
In one case study, it was concluded that a possible pathogenetic link existed between Clostridium botulinum neurotoxin A (Btx) and autoimmune thyroid diseases. The authors noted that given the many people suffering from subclinical thyroid disease without knowing it, and so many people using Btx, thyroid complications may be frequently passing undetected.
Considerations Regarding Botox
While there is benefit to using botulinum for specific medical purposes (for example, it can be used to address upper lid retraction issues associated with thyroid eye disease), I do not recommend its use for cosmetic purposes. I view botox as a foreign body – a toxic one at that – that you are putting into your body. Read the scary 22 page manufacturer’s booklet, which contains mainly a series of warnings and cautions! People with Hashimoto’s need to be especially cautious about toxins, as they are usually triggers for symptoms.
Other Medications (Well Beyond My Initial 9!)
My list of medications that you need to be aware of extends well beyond the first 9 I mentioned in this article, as there are many to be careful about when it comes to your thyroid health. Just a few include:
- Glucocorticoid medications like prednisone, which can suppress TSH levels
- Some antidepressants that act on dopamine pathways
- Certain medications that can increase clearance of thyroid hormones by the liver, such as rifampin, phenytoin, carbamazepine and a class of medications known as barbiturates (a common one being phenobarbital). These can be impactful to people taking hormone medications (you may need to increase the dosage).
- Bile acid sequestrant drugs that are used for high cholesterol (cholestyramine, colestipol, colesevelam) may reduce the liver’s reabsorption of bile from the gut and may reduce the absorption of thyroid medication
- Bexarotene, a Vitamin A derivative used for certain types of cancers
- Ethionamide, an old school antibiotic used for tuberculosis
- Interleukin-2, a type of immunotherapeutic agent used for certain types of cancer
- Thalidomide, the infamous medication that was once given to pregnant women and caused numerous birth defects, now used to treat certain types of cancers
- Sunitinib, a type of cancer treatment
- And the list continues…
The important point here is to realize that you should always discuss any new medication with a knowledgeable health care professional such as your physician or pharmacist (who knows ALL of your medications and health issues). And take charge of your healthcare. Ask questions. Do your own research.
And, don’t forget to ask questions relating to fillers. If you have dairy or gluten sensitivities, you don’t want even a supposedly “thyroid-friendly” medication that has dairy or gluten fillers. Just like I experienced issues with lactose fillers, there has been research on this topic that shows how impactful this can be.
Final Words… Keep Learning!
I hope you have learned a few things that will help you in your journey to feel better.
I know that the information in this article may seem overwhelming, as there are so many diseases, medications, toxins, triggers, and more that can affect your Hashimoto’s, your well being, and generally how you feel. But, take it slow and continue to focus on discovering your root cause.
And, for support and encouragement along the way, join my community if you haven’t already! Sign up for my newsletter to have helpful information delivered right to your email inbox. And join me on Facebook, too. We’re all in this together.
- Harari F, Bottai M, Casimiro E, et al. Exposure to lithium and cesium through drinking water and thyroid function during pregnancy: a prospective cohort study. Thyroid. 2015;25(11):1199-208. doi: 10.1089/thy.2015.0280
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- Dong B. How medications affect thyroid function. West j Med. 2000;172(2): 102–106.
- Armitai M, Zivony A, Kronenberg S, et al. Short-term effects of lithium on white blood cell counts and on levels of serum thyroid-stimulating hormone and creatinine in adolescent inpatients: a retrospective naturalistic study. J Child Adolesc Psychopharmacol. 2014;24(9):494-500. doi: 10.1089/cap.2013.0046
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- Wolkove N, Baltzan M. Amiodarone pulmonary toxicity. Can Respir J. 2009;16(2): 43–48.
- Piga M, Serra A, Boj F, et al. Amiodarone-induced thyrotoxicosis. A review.Minerva Endocrinol. 2008;33(3):213-28.
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- Tsang W, Houlden R. Amiodarone-induced thyrotoxicosis: a review. Can J Cardiol. 2009; 25(7): 421–424.
- Narayana S, Woods D, Boos C. Management of amiodarone-related thyroid problems. Ther Adv Endocrinol Metab. 2011; 2(3):115–126.doi: 10.1177/2042018811398516.
- Shah S, Shah M. Is dronedarone really safe than amiodarone? Indian J Pharmacol. 2012; 44(6):805–806. doi: 10.4103/0253-7613.103308.
- CDC. 2014 Water Fluoridation Statistics. Centers for Disease Control and Prevention.Available at https://www.cdc.gov/fluoridation/statistics/2014stats.htm. Published 2014. Updated August 19, 2016. Accessed January 6, 2018.
- Peckham S, Lowery D, Spencer S. Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. J Epidemiol Community Health 2015;69:619-624. http://dx.doi.org/10.1136/jech-2014-204971.
- Singh N, Verma KG, Verma P, Sidhu GK, Sachdeva S. A comparative study of fluoride ingestion levels, serum thyroid hormone & TSH level derangements, dental fluorosis status among school children from endemic and non-endemic fluorosis areas. SpringerPlus. 2014;3:7. doi:10.1186/2193-1801-3-7.
- Adedara I, Ojuade T, Olabiyi B], et al. Taurine ameliorates renal oxidative damage and thyroid dysfunction in rats chronically exposed to fluoride. Biol Trace Elem Res. 2017;175(2):388-395. doi: 10.1007/s12011-016-0784-2.
- IMS Health Reports U.S. Prescription Sales Grew 3.8 Percent in 2007, to $286.5 Billion. BusinessWire. https://www.businesswire.com/news/home/20080312005158/en/IMS-Health-Reports-U.S.-Prescription-Sales-Grew. Published March 12, 2008. Accessed January 7, 2018.
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The Top 9 Drugs Affecting Thyroid Function
- Lithium. ...
- Amiodarone. ...
- Fluoride. ...
- Birth Control or Hormone Replacement Therapy Using Oral Estrogens. ...
- Proton Pump Inhibitors (PPIs) ...
- Interferon. ...
- Accutane. ...
- Amiodarone. Amiodarone can cause transient alterations of thyroid function tests, as well as overt hypothyroidism or hyperthyroidism. ...
- Lithium. ...
- Interferons (IFN) ...
- Tyrosine Kinase Inhibitors (TKIs) ...
- Alemtuzumab. ...
- Iodine-containing medications and agents.
The most pure form of a natural thyroid medication is WP Thyroid used to be called Westhroid Pure. WP Thyroid is gluten and corn free with no artificial colors and only contains three other ingredients inulin (from chicory root), medium chain triglycerides and Lactose Monohydrate.
Levothyroxine is synthetic T4, and it's the first-choice treatment for hypothyroidism — its common brand names are Synthroid, Unithroid, and Levoxyl. It's a first-choice option because of its effectiveness, low cost, and infrequent side effects.
Hypothyroidism associated with Hashimoto's disease is treated with a synthetic hormone called levothyroxine (Levoxyl, Synthroid, others). The synthetic hormone works like the T-4 hormone naturally produced by the thyroid.
The group of drugs not used to treat thyroid dysfunction, which can result in drug-induced hypothyroidism includes amiodarone, nitroprusside, sulfonylureas, thalidomide, interleukin, lithium, perchlorate, and interferon-alpha therapy.
Just as there shouldn't be food in your stomach when you take your hypothyroidism medication, it's also important to avoid taking any other medication at the same time. Specifically, antacids, calcium, cholesterol drugs, and iron supplements can each interfere with the way the thyroid hormone is absorbed.
Liothyronine (Cytomel, Tertroxin) is a synthetic version of T3 and levothyroxine (Synthroid, Levothroid, Levoxyl) is a substitute for T4. If your hypothyroidism is caused by an iodine deficiency, your doctor may recommend an iodine supplement.
Natural alternatives to levothyroxine. The natural alternative to levothyroxine is a natural desiccated thyroid extract from animal sources. Armour Thyroid contains a natural form of thyroid hormone that comes directly from the thyroid gland of pigs.
Westminster Pharmaceuticals, LLC. Issues Voluntary Nationwide Recall of Levothyroxine and Liothyronine (Thyroid Tablets, USP) Due to Risk of Adulteration | FDA.
The FDA has approved levothyroxine for the treatment of hypothyroidism. It is the most commonly prescribed form of thyroid replacement, largely because it has the most data to support its use. There are several formulations of levothyroxine, but some brand names include Synthroid, Levoxyl, and Levo-T.
- Roasted seaweed. Seaweed, such as kelp, nori, and wakame, are naturally rich in iodine--a trace element needed for normal thyroid function. ...
- Salted nuts. Brazil nuts, macadamia nuts, and hazelnuts are excellent sources of selenium, which helps support healthy thyroid function. ...
- Baked fish. ...
- Dairy. ...
- Fresh eggs.
The end-stage of Hashimoto's is when your thyroid has become so damaged that you no longer have enough thyroid hormones and have to go on medication.
Foods to Avoid
On the autoimmune protocol diet, you remove all grains, legumes, nightshades (such as eggplant and peppers), dairy, eggs, coffee, alcohol, sugar, oil and food additives from your diet.
While the term hypothyroidism simply means an underactive thyroid gland, Hashimoto's disease is an autoimmune condition in which the immune system attacks the thyroid tissue. The destruction of the thyroid gland by the autoimmune attack may result in low thyroid hormone production.
Melatonin increased the thyroid gland size relative to body weight and increased the total T4 content and T4:T3 ratio in the thyroid gland. There was no effect of melatonin on TSH response to TRH or hypothalamic TRH content. Optic nerve section increases serum TSH and T3 levels.
Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levo-T, Synthroid, others). This oral medication restores adequate hormone levels, reversing the signs and symptoms of hypothyroidism.
ANSWER: For mild cases of hypothyroidism, not all patients need treatment. Occasionally, the condition may resolve without treatment. Follow-up appointments are important to monitor hypothyroidism over time, however. If hypothyroidism doesn't go away on its own within several months, then treatment is necessary.
- Weight gain.
- Weight loss.
- Slowed heart rate.
- Increased heart rate.
- Sensitivity to heat.
- Sensitivity to cold.
Drugs and iodine can cause hyperthyroidism. Drugs include amiodarone, interferon-alpha, programmed death receptor-1 (PD-1) inhibitors (such as nivolumab and pembrolizumab), alemtuzumab, and, rarely, lithium.
Your TSH levels will be increased, if: Your thyroid gland is not working as it normally should. Your thyroid gland is infected or inflamed, as in Hashimoto's thyroiditis, or autoimmune thyroiditis. This occurs when your body is attacking your thyroid gland, for some unknown reason.
Taking care of your thyroid health can feel challenging when life gets busy! That's why I’ve put together a stack of resources to navigate the busy season!
Suddenly, it may seem more challenging to fit in the healing activities that you enjoyed over the summertime, whether it was a relaxing vacation, taking time for a restorative yoga class, or more free time to experiment with new thyroid-healing recipes.. Fortunately, I have several great resources that I turn to time and time again when life gets busy, and I need a little help getting a nourishing meal on the table, or supporting my adrenals when they’re feeling a little stressed.. Getting a thyroid-friendly meal on the table can be challenging when life gets busy and takeout is on your way home…here are some great options for meals, snacks and keeping your pantry stocked with nourishing foods.. Captain Soup offers “heat and eat” nutrient-dense food — with grass fed meats, organic fruits and veggies, and nourishing bone broth, there’s an abundance of thyroid healing nutrients in each meal.. I love easy-to-digest, nutrient-dense soups any time of year, but with cooler days ahead it’s the perfect time to add them to your meal plan.. Paleo on the Go : These farm fresh, fully prepared, frozen Paleo and autoimmune protocol meals are hand-crafted by their executive chef and delivered directly to your doorstep, saving you time and offering a healthy alternative to cooking when time is in short supply.. Adrenal Support : I developed Rootcology Adrenal Support to help you support the adrenals during times of stress.. MUD/WTR : If you’re considering giving up coffee, or looking for a new morning ritual that promotes energy and focus, I highly recommend trying “Mud Water.” It contains adaptogenic and brain-boosting mushrooms with a blend of black tea, that support the body’s ability to deal with stressors while promoting natural energy.. My favorite go-to when I need a boost is Bulletproof — their coffee is certified mold and toxin free, so it’s safe for your thyroid when you need a jumpstart on a busy morning.. Supporting our liver is one of the most important things we can do for thyroid health, but taking time for a lengthy cleanse might not feel feasible when you’re in the middle of your busy season.. I love to use a castor oil pack for a quick and easy way to support my liver, and I make sure to use clean and safe personal care products to reduce my toxic load each day.. Made with skin-soothing oils that help to calm redness and discomfort, Pretty Frank’s deodorants keep body odor in check — without the use of aluminum and other toxic ingredients found in conventional deodorizing products.. After pharmacy school, I dabbled in cosmetic chemistry and created a special deodorant formulation in my kitchen, and my husband even created a business plan as part of his Master’s program for marketing the deodorant.. I hope you try some of these resources and find them helpful, as we jump into this busy fall season while taking care of our thyroid health.
Why you should listen – One of the biggest obstacles of treating people with thyroid disease is an improper diagnosis. Many doctors will prescribe medications that don’t work and commonly recommend unnecessary surgeries that end up doing more harm than good. This an experience that today’s guest, thyroid expert Dr. Izabella Wentz, went through as ... Read more
Dave: I actually believe that, Izabella.. Izabella: For people that have the very beginning stages of Hashimoto’s, a lot of times the early symptoms are going to be anxiety and just a feeling that something is off about your body.. Izabella: In my opinion, based on interviewing and surveying over 2,000 people with Hashimoto’s, stress seems to be the biggest thing.. Dave: In your new book, you talk about – it’s like a third of the book – you don’t talk about the thyroid.. Izabella: We’ve seen a few people, and I don’t recommend it, where they’ve utilized probiotics where they have said they can eat gluten without a reaction and dairy without a reaction.. Izabella: I was able to survey over 2,000 people with Hashimoto’s, which is the largest survey of people with Hashimoto’s ever done, to figure out what was working best for them and then include that in my book.. Dave: On that note, Izabella, thank you.
Did you know that, for some people, coffee may interfere with the absorption of their thyroid medication?A while back, I went to dinner with a friend of mine whom I hadn’t seen for some time. Despite being under the care of the best doctors around and taking thyroid medications, she was still experi...
Did you know that, for some people, coffee may interfere with the absorption of their thyroid medication?. Can I take my thyroid medications with coffee?. But, one of the things that many people don’t know is that coffee can impair the absorption of thyroid medications, and thus, it needs to be spaced out from thyroid medications.. Thus, if you are taking other forms of thyroid medications, I recommend keeping your thyroid medications at your bedside, so you can take them as soon as you wake up, at least 30-60 minutes away from your morning cup of coffee and breakfast.. Tirosint, a unique gelcap and liquid formulation of levothyroxine, is the only thyroid medication clinically shown to have adequate absorption with coffee.. A small 1989 study reported that coffee consumption was protective against thyroid disease (autoimmune thyroiditis and thyroid cancer).. Dairy protein is a known, highly cross-reactive food for gluten, and 80 percent of people with Hashimoto’s feel better dairy free as well.. Certain brands of coffee may contain mold, while instant coffee is likely to contain toxins that are harmful to thyroid health.. Instead of caffeine, you may consider trying the following:. Hot lemon water first thing in the morning and throughout the day, will wake you up better than any tea or coffee.. I now drink 1-2 Bulletproof coffee almond lattes daily and 1-2 cups of tea most days, to keep up with my toddler… because I am the one that wakes up with him during the night.. Knowing the source of your coffee can help you avoid mold and other contaminants, while those with adrenal issues — which is many of us with Hashimoto’s — will want to consider weaning from, or even eliminating, caffeine for a period of time, until the adrenals are healed.. Thyroid .
An Interview With Dr. Izabella Wentz on Finding and Treating The Root Cause of Hashimoto's Thyroiditis | Natural Endocrine Solutions ›
This is the transcript from an interview I conducted with Dr. Izabella Wentz. Dr. Wentz is the author of the book Hashimoto's Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause.
Some people might see an increase in thyroid antibodies with Armour, and so in that case I’d recommend doing the T4 and T3 compounded medication.. Dr. Eric : What is the best way, in your opinion, to find a doctor who is willing to prescribe either Armour or compounded T4 and T3?. Dr. Izabella : Selenium is one of those things that I recommend for just about everybody with thyroid disorders.. Dr. Izabella: Yes, that’s usually going to be my recommendation.. Well, if people are already taking thyroid medications or they have Hashimoto’s, iodine deficiency is sometimes the root cause, but in most cases it’s not.. As we both know, it’s not always the same thing for every person that triggers their Hashimoto’s but at the same time there are a lot of universal things that we can recommend that will help most people feel much better.. Dr. Eric : Great and thank you again Dr. Izabella for sharing this information.. Dr. Izabella : Thanks so much Dr. Eric.
Kathy Smith: Izabella, welcome to the show today. I’m excited to have you.
Kathy Smith: Why does your body start attacking your thyroid gland?. What all of these things sort of have in common is that whenever we don’t have enough nutrients on board or we’re eating foods that are inflammatory to us that we’re sensitive to or we have toxins in the body, that sends a message to our body that we’re not safe in our environments.. One of the big things I always talk to women about is what is it in your day-to-day life that’s sending your thyroid gland and your body a message that you’re not safe here.. Stress on the body is going to be not getting enough food.. So, could we talk about why liver is so important and especially this time of year.. The exciting thing is the majority of people – about 80% of the people who do this two-week protocol with thyroid disease actually feel significantly better within the first or second week of going through this liver support protocol.. Kathy Smith: So, supporting the liver can actually kick-start the whole healing then and start to make you feel better after even a few weeks, which is interesting.. Is it the thyroid?. It’s the liver, adrenals and gut, and there’s also various types of root causes.. We talk about that a lot on the show, but I don’t know if it can be even over stated how important having a healthy gut is.. So, there was a lot of stress in my life, and I do believe that having a TV show, getting up at 4:30 in the morning, going, going, going really was part of what triggered everything in my body.. If you liked what we talked about today, you’re going to love Izabella’s book called Hashimoto’s Protocol.
Find out how to successfully treat and reverse Hashimoto’s disease with Dr. Izabella Wentz and the Hashimoto’s Protocol.
Shawn Stevenson: Alright, everybody thank you so much for tuning into the show today.. Shawn Stevenson: Hashimoto's thyroiditis.. Shawn Stevenson: That's my thing.. People didn't see you before the show.. People didn't see you before the show.. And so it's like isn't it in my body already?. Dr. Izabella Wentz: Wow yeah, stress is one of those things that doesn't make anything better, right?. Is that a thing?. Dr. Izabella Wentz: Oh my goodness, ferritin is one of these things that's oftentimes deficient in thyroid disease, and the majority of people who struggle with hair loss, and Hashimoto's, and thyroid disease may actually have a ferritin deficiency.. Whereas other people just need to know like 'what.'