156 Hyperthyroidism or Hypothyroidism? Reasons for Fluctuating TSH
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Thyroid Mystery Solved: Hashimoto's and Hypothyroidism Revealed
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Shortcut to my thyroid program.
The Case:
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Lucy was experiencing symptoms that went back and forth
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She would experience heart palpitations, hot flashes, and anxiety and then she’d have periods of fatigue
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Her doctor suspected hyperthyroidism and tested her for Graves
I knew that there was reason to investigate further because her symptoms weren’t adding up. When it comes to hyperthyroidism, there’s one person I often turn to - Dr. Eric Osansky, a chiropractor and host of the ‘Save My Thyroid’ podcast.
His interest in hyperthyroidism comes from his personal Graves diagnosis in 2008. He is also the author of 2 thyroid books, ‘Natural Solutions for Hypothyroidism and Graves’ Disease’ and ‘Hashimoto’s Triggers: Eliminate Your Thyroid Symptoms by Finding and Removing Your Triggers’
On this show, we talk a lot about hypothyroidism and how Hashimoto’s can be at play. Many don’t think that Hashimoto’s can also be present when someone has an overactive thyroid (Hyperthyroidism and sometimes Graves’ Disease). It all starts by looking at and understanding TSH levels.
Reviewing the Basics of Thyroid-Stimulating Hormone (TSH)
The thyroid gland is a critical component of our endocrine system, responsible for regulating our metabolism. When it comes to thyroid assessments, most practitioners start by examining the Thyroid-Stimulating Hormone (TSH). Dr. Osansky explained that TSH stands for "Thyroid Stimulation-Communicating Hormone" and is produced by the pituitary gland. This hormone plays a vital role in communicating with the thyroid and serves as a fundamental element of many thyroid evaluations.
When it comes to hypothyroidism, including conditions like Hashimoto's, you'll often see elevated TSH levels. This is because the thyroid hormone in the body is on the lower side. It might be just within the lab's reference range, or it could be overtly low. In response, the pituitary gland sends a clear signal to the thyroid: "We need more thyroid hormone!" This signal takes the form of an increased TSH level, prompting the thyroid gland to produce more thyroid hormone.
Conversely, in the case of hyperthyroidism, it's the complete opposite. With hyperthyroidism, there's an excess of thyroid hormone circulating in the bloodstream, mainly bound to proteins. In this scenario, the pituitary gland signals the thyroid to slow down production. As a result, you'll commonly observe not only low TSH but sometimes an undetectable TSH, especially in conditions like Graves' disease. This undetectable TSH indicates that the pituitary is working hard to halt the overproduction of thyroid hormone. So, while TSH levels can provide valuable insights, they're just one piece of the puzzle. We need to dig deeper into the thyroid hormones to get the full picture.
Comprehensive Thyroid Testing is Always Key
According to Dr. Eric, to reach a proper diagnosis, we must also examine the thyroid hormones, particularly free T3 and free T4. These free hormones offer a more accurate representation of thyroid function. In hyperthyroidism, where the thyroid hormones are typically elevated, examining free T3 and free T4 alone is often sufficient because total hormones will also be elevated. On the other hand, in hypothyroidism, some practitioners prefer to assess not only free hormones but also total hormones to gauge production since a significant portion of thyroid hormone is bound to proteins.
Let's not forget reverse T3, an inactive form of T3. It's a bit of a controversial character in the thyroid world. Some suggest that reverse T3 may act as a blocking agent, especially in hyperthyroidism. Elevated reverse T3 levels are common in this condition, further hinting at its role in dampening excessive thyroid hormone activity.
But the thyroid's complexity doesn't end here. We also need to consider antibodies, which play a crucial role in autoimmune thyroid conditions like Hashimoto's. Plus, keep in mind that it's not just the thyroid at play; the pituitary gland could be throwing a wrench in the works too. Pituitary issues, such as a pituitary adenoma, can also affect TSH levels and the overall thyroid regulation. So, always remember that a comprehensive view is essential when evaluating thyroid health.
What is Hashi-Toxicosis?
Hashi-toxicosis is a fascinating term that combines "Hashimoto's" and "toxicosis." It essentially refers to Hashimoto's thyroiditis with intermittent episodes of hyperthyroidism. When someone has Hashimoto's, the autoimmune attack damages the thyroid gland, causing it to release excessive thyroid hormone into the bloodstream. Consequently, when you get a blood test during such an episode, it can appear as hyperthyroidism. However, it's different from Graves' disease, where specific antibodies continuously stimulate the thyroid gland. In Hashi-toxicosis, these episodes of hyperthyroidism are transient, meaning they come and go. The duration varies from person to person, some experiencing these episodes for a few hours, while others may have them for a few days.
These fluctuations can be triggered by various factors. For some, hormonal changes, like those related to the menstrual cycle or stressful events, can lead to these episodes. It's important to note that the frequency of these flares varies among individuals. Some may experience them frequently, while others only encounter them occasionally. In my own journey, I've had a couple of Hashi-toxicosis flares, both linked to high-stress events – one after moving and the other postpartum. These personal experiences have taught me that hormonal changes can significantly influence the frequency of these episodes. For those who face occasional flares, it can be a bewildering experience.
When I had my first episode, nearly two decades ago, it looked a lot like Lucy's situation. The doctor ran tests during a flare, and my thyroid hormone levels were off the charts. Not just my TSH, but all my thyroid hormones were elevated, which was rather unusual. The doctor even suggested the possibility of thyroid removal. Thankfully, my knowledge about Hashimoto's helped me question this recommendation, as I knew there was more to the story than met the eye.
Get Curious About Unusual Thyroid Results
It's absolutely crucial to explore all the possibilities when dealing with thyroid issues and stop the attack on our thyroid gland. Now, consider a scenario where someone, like Lucy, has a low TSH and elevated hormone levels. If it's not clear whether this is a transient episode, it's essential to retest and, most importantly, assess the antibodies. But what if the antibodies turn out to be negative, including TSI? What else could be behind these hyperthyroid symptoms and unusual lab results?
Dr. Osasnsky introduced the possibility of subacute thyroiditis. This condition often arises from viral infections, such as cytomegalovirus or even, more recently, the effects of COVID. It triggers significant inflammation in the thyroid, resulting in excess thyroid hormone production. Strangely, the presentation mirrors Graves' disease, yet the antibodies are absent. However, in most cases, within two to four months, this hyper phase shifts to a hypo state, and often, the hypothyroidism is temporary, eventually returning to a normal thyroid balance.
One more thing to consider is medication. For example, if someone is taking a high amount of natural or synthetic thyroid, (whether it's levothyroxine or desiccated thyroid hormone) it can cause too much thyroid hormone.
Nodules on the Thyroid and What They Mean
In the world of thyroid health, nodules are a hot topic, and I get a lot of questions about them. One common query is, "Can nodules ever cause hypothyroidism?" Dr. Osansky, explains that nodules typically don't lead to hypothyroidism directly. In fact, most of the time, they don't cause either hyperthyroidism or hypothyroidism.
However, there's a bit of a gray area. In some cases, people with larger nodules, especially those over two centimeters, might experience changes in their TSH levels. Sometimes you'll see a depressed TSH with multinodular goiter, but the thyroid hormone levels will appear normal. So it's not exactly the nodules themselves causing hypothyroidism; it's more like a subtle alteration in the thyroid function. Of course, it's essential to consider that the interpretation can vary among healthcare professionals. Thyroid lab ranges can be quite wide, and what's considered "normal" in conventional medicine may not align with optimal thyroid health. It's always a good idea to work with a practitioner who understands the nuances of thyroid function.
Nodules are surprisingly common, especially as we get older. About 50% of people over 50 have nodules, and the percentage increases with age. While you can't always completely prevent nodules, there are some factors to consider. Hormone imbalances, particularly issues with estrogen metabolism, can contribute to nodule development. So addressing this aspect can be essential.
Tests like the Dutch test can help evaluate estrogen metabolites, and you may need to consult a healthcare provider knowledgeable in thyroid health for this. Insulin resistance can also play a role, and keeping an eye on your hemoglobin A1C and fasting insulin levels can be informative. Iodine is another element that can be both a cause and a potential remedy for nodules. It's a bit of a gray area, and the research isn't entirely clear. However, it's wise to be cautious with iodine supplements, as they can worsen nodules in some cases.
There are some self-care practices like castor oil packs that some people swear by, although there's limited scientific evidence. Ultimately, it's a good idea to monitor nodules with follow-up ultrasound
The episode 156 Hyperthyroidism or Hypothyroidism? Reasons for Fluctuating TSH from the podcast Thyroid Mystery Solved: Hashimoto's and Hypothyroidism Revealed has a duration of
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As soon as you find out that you have a thyroid issue, or that you’re diagnosed with Hashimoto's, your instinct is to learn as much as you can. As the internet becomes more and more crowded with information, it can be so difficult to find useful information. And, it can be hard to determine who to trust as you try to navigate your way to overcoming your Hashimoto’s and hyperthyroid symptoms.
I know because I was once in this position and because I’ve spent the last decade helping Hashimoto’s and hypothyroid patients regain their health.
A lot has changed in this time - and more changes are coming (more on that at the end of these show notes) but over the years, I’ve discovered that there are 5 key drivers of success when it comes to overcoming your thyroid issues and Hashimoto’s symptoms. I share them in this episode along with a big announcement about this show and support for anyone dealing with autoimmunity, Hashimoto’s, and hypothyroidism.
The 5 Keys to Overcoming Hashimoto’s
These five proven strategies have made a huge difference for me and many of my clients struggling with Hashimoto's.
1. Diet: Balancing Blood Sugar Is Key
It all starts with food! While everyone's needs are unique, there's one common thread: balanced blood sugar. Eating a balanced diet with all the macronutrients – carbs, proteins, and fats – is crucial. Avoid blood sugar spikes by avoiding excessive carbs at once and pair your meals with protein and healthy fats. Remember, stress can be physical too! Unbalanced blood sugar creates stress on the body, hindering progress.
2. Clean Eating: Ditching Chemicals and Going Organic
Our world is full of chemicals like pesticides and herbicides. Research shows these chemicals can negatively impact our health. So, the cleaner you eat, the better. Prioritize whole, unprocessed foods straight from the earth. Consider going organic, especially for the "Dirty Dozen" – the foods most heavily laden with pesticide residues (check the Environmental Working Group's list). Organic meats and dairy are also beneficial to avoid added hormones and antibiotics.
3. Identify and Address Food Sensitivities
Gluten is a common culprit for many with Hashimoto's. Not everyone needs to be gluten-free, but some may have the DQ2 and DQ8 genes, making gluten processing difficult. When you consume gluten, even without immediate symptoms, the immune system attacks it. This can lead to accidental attacks on the thyroid due to molecular similarities between gluten and thyroid molecules (cross-reactivity).
I personally struggled with gluten for years, but identifying it as a trigger made a significant difference. Consider exploring food sensitivities to see what might be hindering your progress.
4. Targeted Supplements for Personalized Support
Supplements can be extremely helpful, but a one-size-fits-all approach doesn't work. Our immune triggers and thyroid types vary. However, some supplements have been particularly beneficial for me and my clients:
- SPM (Specialized Proresolving Mediators): Helps reduce inflammation and calm the immune system.
- Glutathione: An amazing antioxidant that supports detoxification and promotes immune balance. I recommend the APEX Trizoma Glutathione brand for its liquid form and good taste.
- Vitamin D: Another immune balancer and natural anti-inflammatory. I recommend Designs for Health's Vitamin D Synergy or Vitamin D Supreme.
- Remember: These are just a few suggestions. It's important to find what works best for you.
5. Calm the Nervous System
The nervous system has a powerful influence on the immune system. A calmer nervous system translates to a more balanced immune system. Here are some ways to achieve this:
- Meditation
- Movement
- Visualization
- Reframing negative thoughts
- Releasing negativity
- Setting positive intentions
- Affirmations
- Faith
- Mantras
- Self-worth exercises (like clearing feelings of "not enoughness")
I find meditation and movement particularly helpful. Experiment and find what works for you.
Bonus Tip #1: Building a Morning Practice Can Make a Big Difference
Mornings can be tough, but incorporating a self-care routine can shift the entire day. I recommend starting your day a little earlier, even before the kids wake up (believe me, I get it, I'm not a morning person either!).
The book "The Miracle Morning" by Hal Elrod offers great tips on establishing a morning practice and provides ideas to optimize your early-start time. It’s hard to believe but the benefits of improved sleep quality and stress reduction outweigh the initial sacrifice of a little extra sleep.
Bonus Tip #2: Increase Your Capacity to Receive
This may sound surprising, but it's incredibly powerful. We all want optimal health, vibrant energy, and freedom from Hashimoto's. But sometimes, we struggle to allow ourselves to truly receive these things.
My question for you is, can you allow all of the things you picture when you see yourself in optimal health? Take a moment and really feel this question in your body. How much good health can you really receive without feeling like, ‘Oh, gosh, this is too much’? All the things that you want to be able to do when you are feeling better; when you have more energy; when you lose that weight – how much of that joy can you actually allow and take in?
This might feel like a strange concept, but explore it. Notice any tightness or resistance in your body when you imagine complete freedom from symptoms. Do you feel undeserving of such good health?
We often have subconscious beliefs about deservingness. We may feel good things like joy, love, and health need to be earned. This can block our ability to receive the very things we desire.
You’ve heard the stories about lottery winners who lose their winnings quickly. This is often due to a deep-seated feeling of not deserving it. They sabotage their own success.
The same can happen with health. If you don't feel deserving of good health, your nervous system won't feel safe receiving it. This can lead to unconscious sabotage of your healing journey.
Learning to receive is crucial for overcoming Hashimoto's and any chronic health issues. I have entire programs dedicated to overcoming these blocks: "Clear Your Thyroid Blocks" and my signature program "Thyroid Mystery Solved." You can find more information on my website … which brings me to my important announcement!
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