Although I can’t say that most of my patients experience muscle weakness, I also can’t say that it’s uncommon.  While I see it more in my patients with hyperthyroidism and Graves’ disease, people with hypothyroidism and Hashimoto’s can also experience muscle weakness. In this post I’ll discuss the relationship between muscle weakness and thyroid health, along with other factors that can cause this.

Just as a refresher, there are two main types of thyroid hormones. Thyroxine (T4) is the hormone most abundantly produced by the thyroid, while triiodothyronine (T3) is the active form of thyroid hormone.  Both of these can influence muscle physiology, although T3 is probably the most studied of the two (1).

Do You Really Have Muscle Weakness?

There are a few different ways of measuring muscle weakness to make sure it’s not just overall fatigue the person is experiencing.  One tool is the Medical Research Council Manual Muscle Testing scale.  The differential diagnosis of true muscle weakness is extensive, including neurologic, rheumatologic, endocrine, genetic, medication- or toxin-related, and infectious etiologies (2). Electromyography is also considered in some cases, as it can confirm the presence of a myopathy, and if a muscle biopsy is necessary it can identify an appropriate biopsy site (3).  Speaking of doing a muscle biopsy, this is usually reserved for people who present with acute or progressive muscle weakness who are suspected of having an underlying neuromuscular disorder (4).

Sarcopenia and Thyroid Health

The age-related loss of muscle mass, strength, and quality is known as sarcopenia. There is evidence that thyroid hormone can play a role in sarcopenia in a few different ways.  First of all, it can cause the transition from a slower fiber type into a faster one, which can play a role in sarcopenia (5).  Skeletal muscle quality also relies on the health of the mitochondria (6), and skeletal muscle mitochondrial function is also modulated by T3 (7).

Hyperthyroidism and Muscle Weakness

It is quite common for my hyperthyroid patients to experience a loss of muscle mass.  In fact, this was also the case with me when I dealt with Graves’ disease back in 2008/2009.  Keep in mind that the loss of muscle mass isn’t synonymous with “muscle weakness”, but some people do experience both problems.  The good news is that once the hyperthyroidism has been corrected, over time the person’s muscle mass should increase and the muscle weakness should subside…unless of course if there is another factor responsible for the reduced muscle mass/muscle weakness.

While many people with hyperthyroidism notice that they have a decrease in muscle mass, one of the markers that correlates with this is serum creatinine.  This is part of a comprehensive metabolic panel, and when someone with hyperthyroidism has decreased muscle mass the serum creatinine is usually low.  Normalizing the thyroid hormone levels may help to normalize the creatinine, but this isn’t always the case, as you might also need to do other things to increase the muscle mass, such as eat enough protein and do weight-bearing exercises.

It’s also worth mentioning that some rare muscle myopathies are associated with hyperthyroidism, including myasthenia gravis.  And studies show that treating the hyperthyroidism can improve the muscle response in myasthenia gravis patients (8).

Speaking of studies, I did come across a study which looked to demonstrate the degree of muscle weakness in newly diagnosed patients with Graves’ disease, as well as assess the response to treatment (9).  This was a small study, involving 10 patients, and results showed that muscle weakness is commonly associated with hyperthyroidism and can be profound.  It also showed that the beta blocker Propranolol can improve muscle weakness in people with hyperthyroidism.  Even though Propranolol can decrease the conversion of T4 to T3 I’m still surprised they didn’t use antithyroid medication in the study, although they might have chose to have the patients take Propranolol because side effects are more common with antithyroid meds such as methimazole.

Hypothyroidism and Muscle Weakness

While an excess of thyroid hormone can be a factor in muscle weakness, low thyroid hormones can also be a factor. Thyroid hormone plays an important role in muscle physiology, and while some people who have subclinical hypothyroidism might not experience muscle weakness, it is actually very common for those with overt hypothyroidism.  In other words, if the thyroid hormones are outside of the lab reference range then there is a pretty good chance that muscle weakness will eventually develop.

In fact, a study I came across showed that hypothyroid myopathy affects almost 80 percent of people with hypothyroidism (10).  Hypothyroid myopathy is a condition that presents with nonspecific symptoms of muscle pain, muscle cramps, fatigue, and muscle weakness, particularly exacerbated with exertion and exercise (10).  The authors mentioned that the degree of muscle weakness doesn’t always correlate with the severity of thyroid hormone deficiency.

As for the underlying mechanisms causing the muscle weakness, according to the same study, “T4 deficiency leads to a reduced mitochondrial oxidative capacity, abnormal glycogenolysis (the breakdown of glycogen into glucose) and an insulin resistant state of the cell. This leads to selective atrophy of type 2 muscle fibers (fast-twitching type) as they are dependent on glycolysis for energy causing the slowing of muscle contraction seen clinically in patients with hypothyroidism. Muscle hypertrophy ensues as a result of this, which is believed to be a compensatory response that happens from the accumulation of glycosaminoglycans in the muscle. Increase in connective tissue and muscle fibers also contributed to this hypertrophy”.

If you experience muscle weakness associated with hypothyroidism, there might also be an increase in the marker creatine kinase in the blood.  However, there can be other factors that can increase this marker. The good news is increasing the thyroid hormone levels (i.e. with thyroid hormone replacement) can resolve many cases of muscle weakness, although it can take a number of months for this to occur, and sometimes even several years.

Other Causes of Muscle Weakness

As I’m sure you can imagine, there can be many other causes of muscle weakness.  Here are some other potential causes:

• Amyotrophic lateral sclerosis
• Cerebral lesion (stroke, hemorrhage, mass)
• Compressive neuropathy of the peripheral nerve
• Guillain-Barré syndrome
• Motor neuropathy
• Multiple sclerosis
• Adrenal insufficiency (Addison disease)
• Endogenous glucocorticoid excess (Cushing syndrome)
• Certain medications
• Certain toxins
• Electrolyte disturbances
• Genetic (i.e. muscular dystrophy)
• Infections

I’m not going to cover all of these causes, but I do want to briefly discuss a few of them, including electrolyte disturbances, medications, and infections.  Regarding electrolyte imbalances, while a comprehensive metabolic panel isn’t a perfect way of evaluating the electrolytes, if someone does have low sodium, potassium, and/or calcium then it’s something to pay attention to.  RBC magnesium can help determine if someone has a potassium deficiency.

Some of the medications that can potentially lead to muscle weakness include statins (11), glucocorticoids (12), and fluoroquinolones (13). It’s worth mentioning that the research shows that for those experiencing muscle weakness caused by taking statins, supplementing with CoQ10 can potentially help with this (14). CoQ10 might also benefit some people with hyperthyroidism in general, and not just those experiencing muscle weakness.

Certain infections can also result in muscle weakness.  This includes West Nile virus infection, HIV infection, Lyme disease, diphtheria, dengue fever, neurocysticercosis, trichinosis, Chagas disease, rabies, botulism, herpes zoster, cytomegalovirus infection, hepatitis C, and herpes simplex virus 1 infection (15).  When I was diagnosed with chronic Lyme disease in 2018 I experienced some muscle weakness initially, although thankfully it resolved pretty quickly.

How To Overcome Muscle Weakness

As for what you can do to overcome muscle weakness, you of course need to address the cause of the problem.  If someone has muscle weakness due to hyperthyroidism or hypothyroidism then of course these thyroid hormone imbalances need to be corrected.  If someone has reduced muscle mass and muscle weakness then not only does the underlying cause need to be addressed, but some weight bearing exercises may also be necessary.  As I mentioned earlier, I commonly see this with my hyperthyroid patients, as many of them suffer from reduced muscle mass, and while correcting the hyperthyroidism is important, doing this alone isn’t always sufficient.

I mentioned other potential causes of muscle weakness, and so if any of these are factors then these would also need to be addressed.  For example, if someone has overt hypothyroidism and also has chronic Lyme disease, and if both are factors in the muscle weakness, then it shouldn’t be surprising that both the hypothyroidism and chronic Lyme disease condition would need to be addressed.

Do You Experience Muscle Weakness?

If you currently experience muscle weakness, or if you experienced it in the past and have overcome it, please feel free to share your experience in the comments below.  Thank you!

 

On Friday March 26th I interviewed Magdalena Wszelaki, author of the book Overcoming Estrogen Dominance, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Dr. Eric:

Hello everyone. This is Dr. Eric Osansky and I have with me Magdalena Wszelaki and she is the author of the brand new book Overcoming Estrogen Dominance. So why don’t we start by talking about why you decided to write the book Overcoming Estrogen Dominance.

Magdalena:

So with a lot of us, the same way you started doing Graves’ disease, it’s a personal story. And I struggled with estrogen dominance for as far as I can remember, having terrible PMS as a young girl, and struggling with a lot of bloating, but when I talk about PMS, you’re talking about, it was probably borderline PMDD when you’re in a fetal position on the floor, with painkillers on both sides of your bed, and canceling out one or two days out of the month for school or work because you really can’t get up, and then coupled that with a lot of other things started cropping it including for example, developing lumpy breasts, and sometimes it was just one lump, sometimes it was lumps on both sides.

And I think any woman who finds lumps on her breasts, it’s one of the most the scariest moments that you have in your health history. And you remember that for a long time because first, you go and Google it, and you are convinced it’s breast cancer, and then it’s also like how do you get it properly diagnosed, you’ve got this contradictory information about the different diagnostic tools, and then you have to wait for the results.

And so it was always a very scary moment, but also, a tendency to put on weight around my buttocks and my hips, it was an interesting one. Developing thyroid nodules, having a history of Hashimoto’s disease. So all of those put together and then finding out later with my DNA testing that I am highly predisposed towards being a very slow estrogen metabolizer. If I did a DNA testing for another reason, and I wanted that to be interpreted to tell me whether that area is a problem, and I’ll never forget how the person who did the interpretation, the consultants emailed me and she said, “Your problem is estrogen, not the other things.”

So and not surprisingly, on both sides of my family, there are estrogenic cancer deaths. Breast cancer, ovarian cancer, uterine cancer run on both sides of my family. So it was a personal story, but then I also started realizing that estrogen dominance is so prevailing with a lot of other hormonal imbalances, so like Hashimoto’s, women generally with thyroid conditions tend to have it, menopause, perimenopause. It always is coupled up with something else, and yet, no one was really talking about it. There was information that’s a bite away thing or it’s all over the internet, or is informal blog posts, or research that no one has interpreted to layman language.

And let alone turn it into recipes, and so I decided, “You know what? I’m going to do this.” And that was the result of creating a 400-page book. That’s not just a health book, but it’s also a cookbook.

Dr. Eric:

And one of the great things about the book is even though it’s 400 pages, I found that you don’t have to read every single chapter. Probably the first few chapters, but there’s a number of chapters in between. So thyroid nodules, which I’d love to talk to you about, fibrocystic breasts, uterine fibroids. So again, if someone wants to go through the entire book that’s awesome. But if they want to just cover some of the book, I guess you would say maybe the first few chapters and then in the middle they could pick and choose, and then at the end you get into the diet and the recipes and the supplements.

Magdalena:

That’s correct. So you’re absolutely right. The first few chapters is what I call the estrogen reset foundation. So you’re resetting your ability to metabolize estrogen in the first few chapters, and that really takes care of your gut, your liver function and your blood sugar levels, and I’m sure those are all the three areas you talk about a lot as well in your own protocols. And so that’s the foundation and I was talking about that it’s really paramount to get that right and do that first.

It’s very tempting to jump onto the feather chapters like go into the thyroid nodule protocol and tinker around with some essential oils on your thyroid and stuff like that. But if you don’t cover the foundation, and really fix your gut, stabilize your blood sugar levels, detox your liver gently, these nodules, they’re not going to go away just because you’re putting Frankincense on it. So that’s how I wrote the book. But if somebody has done the foundation, and then after that, for example, the thyroid nodules persist, or your breasts are still very painful and fibrocystic, then add on that protocol as you’re going through things. Do you want to talk about the giveaway of the book?

Dr. Eric:

Yeah. For anyone who trickled in late I’m chatting with Magdalena. I have her book as well, Overcoming Estrogen Dominance, and she’s going to be giving away a book during this Facebook Live.

Magdalena:

Yeah. So we decided to do that, based on a question we’re going to pop sometime towards the end of the interview, so we mustn’t forget.

Dr. Eric:

Yeah.

Magdalena:

And the question is gonna be based on something that we’re going to be talking about. So we’re going to quiz you guys here a little bit. And whoever gets it right, we’re going to select one person and contact you for your address and mail the book over to you.

Dr. Eric:

All right, that’s awesome. So that’s exciting. So what are some of the common symptoms associated with estrogen dominance?

Magdalena:

I’m so glad you asked that because that is one of the most underestimated, I think, hormonal imbalances, same as with Hashimoto’s, a lot of women go undiagnosed, misdiagnosed. I think when it comes to estrogen dominance, it’s really not even on the radar of most practitioners. And yet, it’s something that almost every woman experiences to some degree in her life. And so let’s go over the list. So first of all, women who are still menstruating, having irregular periods, heavy periods, absent periods, periods that are incredibly painful, so PMS, PMDD, dysmenorrhea.

All of those can be due to estrogen dominance. Then you also have something almost every woman struggles with and that is fibrocystic breasts, some women can have it throughout their entire cycle. Some women it is regardless of the cycle that just have it, having lumps on your breasts, having really painful breasts, so much so when putting on a bra or trying to exercise especially anything that requires balancing is extremely painful and uncomfortable. Fibroids, 80% of African-American women will develop fibroids at one point in her life. A lot of times, we don’t even realize we have a fibroid, very correlated with women with heavy periods. Uterine polyps, something that a lot of women get diagnosed with and Western medicine’s perspective on it as to remove the uterus.

Speaking of thyroid, thyroid nodules as well as thyroid cancer can also be estrogenic and oftentimes are. In fact, the estrogenic cancer category is estrogen receptor positive breast cancer, uterine cancer, ovarian cancer, thyroid cancer, lung cancer, non-smokers is also a form of estrogenic cancer, and a little bit more benign things, but can be also annoying for a lot of women putting a lot of weight around their hips. So fat and cellulite around the hips and thighs and buttocks. And no matter how much you exercise, it just would not go away. And so this is as I said, at the beginning, I’m highly estrogenic, I can be highly estrogenic if I don’t take care of myself.

So if I do put on weight, it all goes down there and that’s typical. So your pear-shaped women tend to be very estrogenic, women who put weight around their abdomen tend to be more in the metabolic spectrum. So high testosterone, high blood sugar levels, insulin resistance potentially. So I would say those are the main ones. Sometimes, this also can be correlated with other things like having varicose veins on your face, melasma which is also a super annoying thing is a brown spotting for a lot of women will be above your lips, it might be around your forehead around here, in the temples. Some women would even get melasma on their breast and chest.

So I would say those are the main ones. I would also just throw in here that having things like mood swings, terrible mood swings can be also due to estrogen dominance, especially before your period. Women with infertility problems, this is especially due to low progesterone levels. So there are different types of estrogen dominance. Maybe we can mention that in a second, but one type is that when you’re low on progesterone and that infertility or early miscarriages in the first trimester can be correlated with that.

Yeah, I would say those are really the main ones. Actually, there’s more. Oh, let me also not forget. Since you’re a guy, and I’m sure you have some men following, prostate problems in men and prostate cancer can also be due to high estrogen levels. Men have estrogen too, it’s just a lot less than women. But you still depend on the same mechanism as women and that is how do you metabolize it. How do you break down those estrogens is also dependent on your diet, on the health of your liver and your blood sugar levels.

Also man boobs. I was just reading the other day that one of the biggest corrective surgeries for men, for women it would be facelifts and botox and breast implants and stuff. For men, it’s actually breast reduction. And so again, men boobs are due to estrogen because estrogen is what makes women, women. And so X is estrogen. This is super common for men who like to drink a lot of beer. Beer, especially hops-based beer, hops are highly estrogenic. So that’s part of the reason. So one of the questions I get a lot is, “If I do your protocol Magdalena, can my husband and my kids do it?” And the answer is absolutely, yes.

There’s nothing in these protocols that will make your man grow boobs. In fact, it’s the other way around where we have a lot of women telling us that when they implement the protocol for the whole family is that their guys sleep better, they snore less, they have less sleep apnea, less restless legs. They have better mood, they have more energy, they’re just much more pleasant to be around with and they lose weight.

Dr. Eric:

You mentioned the surgery and it’s sad that a lot of men will go ahead and get the surgery, yet it’s not doing anything to address the cause or the problem and the estrogen dominance. And speaking of the cause, as you mentioned, the foundations, healthy gut, healthy liver, blood sugar, but you also did mention genetics. It looks like your dog is in the background.

Magdalena:

I’m so sorry. I forgot to…

Dr. Eric:

…excited about this presentation here too.

Magdalena:

Yeah, woohoo.

Dr. Eric:

No, that’s okay. We have two dogs as well here.

Magdalena:

I’m so sorry. Yeah. Would you just hold on a second? Let me just ask them to come over here and-

Dr. Eric:

Sure, sure. And in the meantime, if you have any questions… Magdalena, will be right back. Just taking care of her doggies. But until then, if you have any questions let us know. She does have another interview right after this for her book. But again, if you popped in late, we’re talking about Magdalena’s book, Overcoming Estrogen Dominance. So if you have any questions, feel free to put it in the chat. And we will try our best to get to your questions. We’ll definitely get to a few questions and hopefully we’ll be able to answer all of them. But yeah, definitely check out her book Overcoming Estrogen Dominance, a really good book… I think she’s back here. So let me add her back.

Magdalena:

Sorry about that, that’s what happens when we have two very lively young terriers.

Dr. Eric:

Yeah, no, no, no worries. I think we’re all used to it. If it was two years ago, maybe it would have been a little bit different. But now, with everything going on-

Magdalena:

It’s just so much more real, right?

Dr. Eric:

Exactly. So what I was going to say as far as the causes. You also mentioned genetics. So it sounded like you had some genetic issues. You talk about COMT, a slow COMT being a big cause of estrogen dominance?

Magdalena:

Yes, that’s the biggest one correct. There are a few other ones and I covered them in the book that make an impact, but it’s more of an indirect one. The direct one is the COMT gene. And just to tell you how bad it was, when I went to see a colleague of ours, Dr. Jill Carnahan, she was my physician here in Boulder, Colorado. When I went to see her for the first time about three years ago, and I brought my whole print out of my labs with me as she was going through it and as she’s flipping through it, she didn’t really know me as a person. We were not really friends back then yet.

She’s flipping through the whole material, and she says, “Have you had breast cancer?” I’m like, “Whoa, no. Why would you say that?” It’s just because with these kind of genes, I see women your age and that time I was 45, women your age, with these kind of genes I would have seen breast cancer by now. So I think I dodged it just because I do this work. Well, I did this work, but I also live this life. And if you ask me what is my biggest fear in life, my biggest fear is that I’ll develop breast cancer and go down the path of my aunts on both sides. And it’s not a good quality of life. And before they even had cancer, they just never really had a happy, healthy life, a vibrant, there’s always stuff going on.  There was all this female stuff as my family will call it, female problems. I don’t want to have female problems. I just want to be a healthy, vibrant, individual. So I’m 48 today, and I always joke about that I feel better than when I was 28. So it’s completely manageable, in spite of what your genes are, you just have to put a little bit more work towards it.

Dr. Eric:

And I don’t think you mentioned in the beginning, maybe you did, but that you also had the antibodies for Graves’ and Hashimoto’s. And then also by reading your book, I didn’t know you also had thyroid nodules. Correct?

Magdalena:

That is correct.

Dr. Eric:

To shrink them I assume by addressing the estrogen dominance, the estrogen metabolism problems?

Magdalena:

Absolutely. And a couple of years ago, I went to get a sonogram on my thyroid and the technician and I were chatting, and she had some sleeping problems. So I started giving her advice. So we became fast friends while I was on that bed. And she said, “I’m not supposed to comment on what I’m seeing. But I will just tell you off record that somebody with a history of Hashimoto’s and Graves’, I’ve never seen such a healthy tissue.” So it was a colored version, the latest kind of scans that you can get. And she says it was beautiful pink. Nice one.

So anyway, it’s completely reversible, it’s completely manageable. I think for a lot of people with thyroid nodules … what happens when you go and see a doc, right? Your typical endocrinologist will tell you just wait and see, come back in six months’ time. And then if they biopsy that, and they consider it inconclusive, they will recommend surgery from which they also make a lot of money from insurance. But to your point, and this is why we do this work, it doesn’t address the root cause of a problem. It’s an autoimmune problem, or it’s an estrogen dominance problem with nodules, with autoimmunity, and so really addressing that, it was something that I’ve always been on a mission to do.

So completely reversible. I don’t have them anymore and I think a lot of a lot of people go like, “Well, let me ask you this, if you had a nodule right in here under your skin, you do something about it.” I feel like when something is inside here, we don’t really see it. Very few people know how to go and look for it. Because we’re not really trying to do it. Then it’s like, “We just let it be.” But it’s not about putting anyone in a state of panic, it’s just your body’s way of saying like, “Hey, I’m really struggling here with metabolizing this estrogen.” And I just happened to be depositing that estrogen into your thyroid, and so do something about it.

So those are your early signs that something needs to be done. The other symptom I forgot to mention is gallbladder. So many women suffer from gall bladder problems. And it’s an interesting one between estrogen dominance and gallbladder because you can have estrogen dominance that causes gallbladder issues, or rather, the thickening of the bile that then builds up the gall stones and in the tracks and that’s what causes the problems of releasing bowel and demount when we need it. But you also have the other way around where the removal of the gallbladder let’s just say you’ve had a poor diet before you join this community. So you had a poor diet, you haven’t been eating all that great.

Dairy sensitivities are a big cause for gallbladder problems. But then you have the gallbladder removed and are told that nothing changes, you don’t really need a gallbladder to function. We have 250,000 surgeries of gallbladder removals in the United States and Mayo Clinic said that apparently, 70% of them are unnecessary, it can be reversible. The problem for women with gallbladder removal, something that your doctor doesn’t tell you, and most women don’t connect the dots is that after gallbladder removal, depending on that person about between six months and what supplements you’re taking, six months to two years later, suddenly the woman starts developing really severe symptoms of estrogen dominance, any of those that I’ve mentioned, and we don’t make the connection that was because of the gallbladder removal.

The reason why that happens is because the bile is not just there to emulsify your fats and help you digest fatty foods. But the bile also binds up your dirty estrogen. So I’m hoping that we can talk a little bit about the different forms of estrogen dominance and why that happens because I don’t want to demonize estrogen.

Dr. Eric:

Yeah, I know you said low progesterone. So that’s an example where you don’t have to necessarily have high estrogen. So why don’t you talk about this? You said there are three different types of estrogen dominance.

Magdalena:

Yeah, I’ll cover the main two ones because I think those are the most adjustable ones. I have all the three in my book, but so the first one is what I call the unbalanced partner since we are on that. This is where your estrogen/progesterone ratio is unfavorable. And the interesting thing is that even when you are in menopause or perimenopause, when all your hormones start slowing down, especially the reproductive organ hormones, estrogen and progesterone. So you could be low on both of them. But even though you’re low on both of them, still the ratio between estrogen and progesterone might be unfavorable.

And then that could be one reason why we are estrogen dominant. Especially, we are talking here about the comparison of progesterone to estradiol, E2, which tends to be the more aggressive form of estrogen. Then you have another form of estrogen, which is also incredibly common, and easily manageable to be perfectly honest. And that is what I call ugly breakup. So ugly breakup is basically … Shows you and you can test for it on their test to show you how you break down estrogens into clean estrogens and dirty estrogen. So if you’re a practitioner, it’s what we call antagonistic metabolites.

Now, I don’t want to demonize estrogen because if you’re a woman listening to this, the only reason why you’re listening to this and comprehending things and absorbing information, you’re sitting straight, and you have some muscle strength and healthy bones is because you have estrogen, that makes us women, that gives us cycles, healthy bones, healthy skin, hair, mental cognitive function. And so estrogen is not bad in itself, we need it to function. The problem is how you break down estrogens into metabolites. Think of it this way. Imagine standing on a side of a river and this river is flowing, and right in front of you is this beautiful, whatever, Rocky Mountains river and you have this bank in the middle of the river, and this bank will separate the water into a clean stream and a dirty stream.

So in the body, the function of that bank is your liver. That’s what happens, that’s where the metabolism of estrogen happens. Not only the liver, the gut also, there is some mechanism there when it comes to gut bacteria that break down estrogens as well. But the liver really plays a huge role in this. And there are a couple of pathways, the methylation pathway, the sulfation pathway and the glucuronidation pathway. They’re responsible for breaking down those estrogens. So how healthy and clean your liver is, this is going to be hugely correlated with how estrogenic you could potentially be. And again, the same thing, even if you’re low on estrogen like women, one of the funny emails that we get on a regular basis, even we try to fix it with a copy somehow doesn’t work is that there was a quiz on my website.

And then women take the quiz and they say, “Your quiz doesn’t make any sense.” It says I’m low in estrogen, and I’m in menopause.  Correct. But it also tells me that I’m estrogen dominant, and that doesn’t make any sense. And we explained it in the copy, but a lot of people don’t read it. And so that’s what I’m trying to explain that even though you’re low in estrogen, the little that you have how you break it down, it can make a big difference. So not surprisingly, my whole cookbook, my whole book, and the recipes are very supportive of using fruits, vegetables, fiber that are specifically targeting liver health.

Dr. Eric:

All right. So we also just want to remind anyone who came in late, we probably should let them know that. First of all, we’re discussing Magdalena’s new book, Overcoming Estrogen Dominance. And then we’re also giving away a book… We’re going to ask a question towards the end. So for one lucky winner who will answer that question, that person will … We’re going to randomly choose, is that how we do it… I’m new to these book giveaways.

Magdalena:

Yeah, my team generally picks someone randomly, unless you have … Sometimes we pick somebody who’s very active, ask a lot of questions.

Dr. Eric:

Okay. Speaking of questions, I just want to get to this question because it does lead to one of the questions I was going to ask you. So one of the Facebook groups asked, “What tests can you take to find this out or is it just based on symptoms?” So I know you have an answer for that and I know the answer, but we’ll let you give the answer.

Magdalena:

Okay. So symptoms are obviously very telling and it depends, if you’re really on a tight budget, then going with symptoms and helping yourself by making changes to your diet and adding a few supplements will definitely help. If you have the funds and especially, I do recommend it for women who have a history of estrogenic cancers, managing and or by identical hormones, I hope you’re not taking any synthetic hormones. Then breaking down, managing that element of how you’re breaking down estrogens is going to be really, really important. So for that, I really like the DUTCH, D-U-T-C-H that shows you your estrogen metabolites. This is going to be really helpful to see and understand that. Do you do interpretation of DUTCH?

Dr. Eric:

I do. If someone just wants the adrenals tested, a lot of times I still will do salivary testing. But for looking at sex hormones, I agree, dried urine testing, and specifically the DUTCH test is something I recommend.

Magdalena:

Yeah. And I will also say that blood testing is completely useless when it comes to certain markers. Some people might say that morning cortisol is helpful. Cortisol is not my gig, but I can tell you right now from an estrogen/progesterone perspective, if your doctor has done blood testing then it’s not going to tell you pretty much anything. I remember when I was in private practice, I’m not anymore, but when I was, I used to have women walk into my office and say, “Look, okay, those are my labs, this is my estrogen, my progesterone. My doc says everything is perfect.” And fair enough, it was all within ranges.

Nobody asked her which part of the cycle she was in. And then yet, this person, when you look at her intake form, has got a history of fibroids, she’s got terrible, heavy periods running for 20 days at a time, history of breast cancer in the family. Screaming estrogen dominance, and her physician is telling her that her labs look great. So blood is completely useless. I agree with you. I like saliva, also, for another reason that I feel like it’s a better marker of progesterone. DUTCH estimates progesterone where the saliva actually shows you more … I think it’s just another really great market to look at with that. So saliva and urine for sure.

Dr. Eric:

Like you said, the big advantage of urine testing is that it looks at the metabolites. Saliva doesn’t do that, blood doesn’t do that. So if you want to look at the two hydroxy, four hydroxy, 16 hydroxy… There are other urine test that look at these. I know DUTCH isn’t the only one, but it’s the most common one, it’s the one I use and it sounds like the one you use. So yes, anybody looking for symptoms to start out with maybe like you said, if they can absolutely afford the DUTCH test, and this test also looks at the adrenals, looks at melatonin and looks at some organic acids.
So it’s really a good test. So I’m just looking, we got those questions, I think you triggered a bunch of questions coming in with that. So all right, “Is there a link between hypothyroidism and estrogen dominance?”

Magdalena:

Perfect question Madeline. And the answer is yes, absolutely. So they often go together and in fact, I said it earlier in our interview that I hardly ever see women having just one hormonal problem and typically comes in sets of two or three. So yes, and the mechanism behind it is that when you have high estradiol or you have high metabolites, dirty estrogen is what I call those metabolites, unfavorable metabolites. What happens with estrogen dominance is that excess estrogen binds up thyroid binding, it binds up your thyroid hormone basically.

And so even though you might be producing a sufficient amount of thyroid hormone, the excess estrogen is going to bind it up and up and hence causing or making you feel like you have hypothyroidism. So yeah, definitely. The other thing that happens is that estrogen dominance also can cause the growth of thyroid nodules. And that’s an interesting one because a lot of women who are really hypo suddenly also have bursts of being hyper during that time.

So for those of you who have been swinging between those two, I used to have that swinging happening. I think there are different theories why that happens, but one of them for sure is the fact that thyroid nodules can also produce additional thyroid hormone making you hyper even though you’re hypo so you’re just swinging between those two. Lastly, estrogen dominance just causes a lot of inflammation. And since most hypothyroidism cases are Hashimoto’s, and if you haven’t been tested, I highly recommend for you to get tested for Hashimoto’s antibodies, and when you have Hashimoto’s, you already tend to be on the inflamed side of things.

And so estrogen dominance is like adding fuel to the fire. So all around, yes, absolutely. That’s why a lot of women who have hypothyroidism also have fibroid issues, lumpy breast issues, painful breasts, terrible PMSs and periods, etc.

Dr. Eric:

All right. Great. Thank you for that explanation, and we have a bunch of questions here. Marina asks, “Can IVF cause Graves’?” I don’t think so Marina as far as I know, I don’t think in vitro fertilization will cause Graves’. I don’t know if you have any opinion on this.

Magdalena:

No, I really don’t know much about that.

Dr. Eric:

Okay.

Magdalena:

There’s a question on birth control. I don’t know if you want to do that one. I think it’s a good question.

Dr. Eric:

This one here?

Magdalena:

Yeah. “Also, my surgeon recommends I go on low dose birth control of estrogen, but I don’t want to as it has synthetic hormones and I’m sure will increase estrogen. Should I really stay away from birth control?” So I’m curious what your take is, but I’ll just tell you mine. First is that one thing that I find really amusing on one hand and really frustrating on the other, is when your doctor tells you that it’s a low dose birth control. Have you ever heard of a high dose birth control? A normal dose birth control?

So it’s marketing … First of all, there’s a marketing spiel that’s been created by the pharmaceutical companies on birth control pills that just make you believe that you’re on the lowest dose possible. They don’t even test your hormones to determine the dose that you need. Okay. Our colleague Jolene Brighten has written a great book called Beyond the Pill, and it’s a really wonderful book about getting women off birth control. So for those of you who have younger kids or younger women who struggle with it, I highly recommend to get that book.

But what I have learned from her, just a short version of this is that first of all, when you go on birth control, birth control pills are nutritional muggers. They mug you of Vitamin Bs, magnesium, zinc and guess what? All these minerals, all these vitamins and minerals are essential. For example, B vitamins are essential for detoxifying your liver, and you’re basically impairing the ability or just you’re basically flushing them out of your body, depleting yourself of B vitamins, impairing your liver’s function, and hence, your estrogen metabolism is not going to be as effective.

Magnesium, how many of you here are craving chocolate? It’s almost like a women’s thing. It’s like, “I love chocolate. I can’t live without chocolate.” And it’s like a cultural, joke kind of a thing. But actually, there is a reason behind it. Cacao is high in magnesium, every time you have chocolate, your body’s like, “Oh, thank goodness, I’ve got some magnesium here. I love you for this. Bring on more chocolate.” Problem is there’s sugar in that. So yeah, so all around and most importantly, a lot of times, doctors put us on birth control pills without addressing the root cause of the issue.

So you ask yourself why is your surgeon putting you on birth control pills? Is it really because of contraception? Because there’s a lot of other things you can do with contraception.  Or is it some other reasons? And is it to regulate your periods? Because that’s not stated here. Is it to regulate your periods? Is it to make the periods less painful? What is the reason? For example, let’s just say your periods are irregular, that’s not the way to fix a problem. Okay. So, and actually, your periods tell you a really great story on your overall health, the same way your hair tells the story of your health, your skin tells the story how healthy are you on the inside.

Your periods tell you how healthy of a woman are you. So I think I just want to congratulate you on your intuition to consider staying away from that. And so I would definitely work with somebody like Dr. Eric Osansky to really uncover what is the root cause of your issue. And yes, it will increase estrogen and I will tell you right now, one of the early symptoms that I already knew that I had problem with estrogen was that I’ve been on birth control pills for six months. It was the worst six months of my life. Worse. I felt so off, my breasts were so painful. I used to play a lot of tennis. I couldn’t play tennis.

I didn’t want to have sex, I had headaches all the time. And so I think it was because I’m such a bad estrogen metabolizer, and I had enough intuition, but though I didn’t know any of this back then was just not to do this. And congratulations on your own intuition and to ask this question, so thank you for that.

Dr. Eric:

Yeah, and this question relates to the birth control too in that Victoria wants us to repeat the correct test for hormones and we’re going to talk about dried urine testing with the DUTCH test, but if you’re taking birth control , you wouldn’t want to do the DUTCH test because it’s going to be throwing off those hormones. So if you’re testing for hormones while on birth control, it’s not going to give an accurate reading.

But yeah, dried urine testing is what both Magdalena and I use and recommend. And I definitely agree with what you said with the birth control and good point with the B vitamins and magnesium. B vitamins are also important for adrenals as well.

Magdalena:

And zinc. Zinc and magnesium are essential for progesterone production, for example. And for your immune system. And most of you guys are here probably because of Graves’ and Hashimoto’s and here you are depleting yourself of zinc. One of your immune system nutrients. So yeah, good question.

Dr. Eric:

All right, Rachel, thanks for bringing up the DUTCH test. And then here we have Diane, “Once one has testing in hand, is jumping to bio-identical hormones usurping the opportunity to address underlying causes naturally with diet?” Yeah, and I think you would agree. I forget if you mentioned this in your book. But in some cases, if someone has a complete hysterectomy, then maybe that’s justification for taking bioidentical hormones. But the problem is if someone goes to a doctor who prescribes bio-identical hormones, almost everyone will get a prescription for bioidentical hormones, even those who probably don’t need bioidentical hormones.

Magdalena:

Yeah, so you have a very good point. And women with a hysterectomy, women who are very stressed out during a certain period of time, let’s address this in a second. But I want to show you this pyramid I have in the book, let me just get this centered and it’s called, I call it the healing pyramid. The bottom of the pyramid is food. What it says is always first, then you have herbs. I’m an herbalist, so I love herbs and in culinary applications, and then the supplements which I call it often. So food is first and always, herbs are often supplements sometimes and medications.

And medication is only when needed and I consider bio-identical hormones in the RX staying on top and it’s not to say that you don’t do it. There are times when you do need your thyroid blocker because you’re just going completely berserk, right? But then you work on getting yourself out of it and the same thing. So the challenge is like what you said about going to a clinic that specializes in bio-identical hormones is they don’t get to ask and ever correct your diet. They’re never going to replenish and correct your nutritional deficiencies. And my challenge with getting DUTCH testing done, it will be like boom, okay, we’re going put you on estradiol, estriol and progesterone or DHEA or testosterone or whatever, you’re getting the whole combo.

And the challenge I find with that is that you are not addressing the biggest question which is why is your body not producing your own hormones properly in the first place? Or why are you not metabolizing these hormones in the first place? And by going on these bio-identical hormones, I think sometimes temporarily it’s really helpful just to get you settled and calm you down and enable you to focus. And so when you read books like mine, you can actually process it and get to the kitchen and have the energy to prepare something. But a lot of times, it’s something that we just take forever while we are magnesium-deficient.

A huge one, one of my absolute favorites when it comes to hormonal balance. So let’s talk about magnesium deficiency. Let’s say they don’t correct the magnesium deficiency, they don’t even test for your magnesium. They don’t look at the other symptoms like for example, the fact that you’re having sleeping problems. You’ve got a lot of cramps, you wake up in the middle of a night with massive pain around your shoulders or you’re cramping around, you’re constipated all the time. But they don’t address the magnesium deficiency.

They’d rather put you on a whole bunch of … Even if it’s by identical hormones, but you see then when you have this magnesium deficiency not addressed, then you go like, “Oh, then we’re going to give you stool softeners and then we give you something for the sleep.” And the next thing you know, you are taking 20 supplements and spending 500 bucks a month. And so this is where I think the challenge is and I will say if I had a complete hysterectomy, I definitely would consider going on certain hormones, although it’s really interesting that the body is so amazing certainly if you had a hysterectomy, you’re going to go into menopause sooner or later, but the adrenals step in, and guess what? The adrenals then when there’s an absence the adrenals step in and you’re in menopause, but you’re still producing your estrogen and progesterone through the adrenals which is really fascinating.

And so some women don’t even need to go on bio-identical hormones. But if you’re feeling like you’re brain dead, you got your bone density testing, it’s not looking great, your mind isn’t working particularly great then consider bio-identical hormones, but always in combination with some supplements and a really good diet.

Dr. Eric:

Right. And you bring up a good point about progesterone and estrogen. If someone has low progesterone causing estrogen dominance, they could take something such as chaste tree (vitex), but instead of bioidentical hormones, that’s sometimes an option I’ll give, but the number one thing I’ll try to do is try to improve the person’s adrenals. Just doing that could do wonders for low sex hormones as well.

Magdalena:

Yes.

Dr. Eric:

So now as far as some of the treatments, I don’t know if you want to talk more about food. Of course, the book goes into greater detail, but if you could give a few tips as far as either diet or supplements, I know there’s diindolylmethane, DIM, I’ll let you take over as far as what types of treatments do you recommend?

Magdalena:

Yeah, so let’s just talk about maybe the liver. Definitely a favorite organ when it comes to balancing your estrogen levels. I’ll give you three pointers on what you can incorporate right away today. It’s a Friday today, hopefully you’re going shopping over the weekend. First thing is that you want to surround yourself with really great cruciferous vegetables. So the brassicaceae family of vegetables will be things like broccoli, cauliflower, kale, collard greens, arugula, radishes, turnips, we are going to spring now, radishes … It’s a really great time to buy young radish especially if you go to shopping in farmers market.

These cruciferous vegetables, so it’s the brassicaceae family, the cabbage family, they contain a number of different substances including DIM, diindolylmethane. They also contain some levels of sulforaphane, broccoli sprouts are amazing. By the way, they’re very high in sulforaphane. Sulforaphane kills your breast cancer stem cells, how amazing is that? So throw away the lettuce. There is nothing in the lettuce that’s going to be nutritionally beneficial for you. Okay? Maybe this summer, consider not growing a zucchini which also nutritionally speaking, the density in a zucchini, there’s nothing wrong with a zucchini, it just make you food you’re eating really nutritionally dense that it’s like a bowl of medicine that you’re feeding yourself.

Note: while iceberg lettuce doesn’t have any nutritional value, some other lettuces do have a good amount of nutrients, including organic romaine and green leaf lettuce.

So instead of doing lettuce, incorporate arugula or mustard greens, instead of doing lettuce or instead of doing zucchini, consider chopping up some broccoli or broccolini into your salad or if you can’t do it raw, then you can steam it lightly too. And so all of those are just absolutely wonderful. Your liver is going to love you for that. They also have slightly better quality to them. And the bitterness is something that the liver loves. So the next thing as I mentioned is bitterness. So the liver loves bitters period. In a lot of cultures, bitters are something that is drunk before or after a meal.

If it’s before, it’s an aperitif, if it’s after, it’s a digestif. The French have it, the Swedish have it, the Italians have it and it’s always there to prepare your digestion for receiving food and extracting the best out of your food. But guess what? The liver also loves anything that’s bitter. So you can do a couple of things. If you like digestive bitters, we just formulated our own. Have I sent you our digestive bitters?

Dr. Eric:

No, you have not.

Magdalena:

Okay, I’m going to do it after this call. We formulate a really good-tasting digestive bitter, something you take before a meal and we have another one that’s after a meal that really helps. But even doing things like burdock root tea or dandelion root tea. Today when you walk into most health food stores, if you can look at a tea section, back in the day like 10 years ago, there was two hippie teas kind of thing. Now you have 20 brands and 100 products out there that are non-caffeinated.

And just look for those ones that deliver support once and look for dandelion roots, artichoke or burdock root and have that after or before a meal. Most people will prefer to do it after a meal. That bitter quality is going to tremendously help your liver. The third thing that helps the liver in a huge way is fiber. And flax seed is really wonderful to incorporate into your daily diet. A couple of tablespoons of flax seeds freshly ground, I want to emphasize the word freshly so you don’t buy flax seeds as being per ground in the flax meal form. You can pre-grind it and put it in a little jar and keep it in the fridge for about a week or so.

Not only is it a great source of fiber for both soluble and insoluble fiber, but you have to remember that fiber not only is going to help you with your digestion as in help you eliminate and just a little pointer here. Anyone who’s constipated, not only are you taxing your liver, but you’re recycling all these estrogens, the dirty estrogens I talked about over and over again through your body. So incorporating some flax seeds can really be super beneficial. One of the questions that I get and I thought I mentioned that here that’s like, “Hey, why are you suggesting flax seed? Since flax seed contains phytoestrogens, naturally occurring estrogens. I’m already estrogen dominant. Why on earth would I be adding more estrogen to my diet?”

And that’s a valid question. But remember, your problem is not having too much estrogen. Your problem is most likely how you’re breaking down those estrogens or your level of progesterone to estrogen. So having some estrogen from foods, there’s nothing wrong with that. In fact, flax seeds in the studies helps you to skew the balance towards the clean estrogens away from the dirty estrogens and actually works on a receptor and it blocks the antagonistic metabolites from coming through. So it really helps you, it’s quite amazing. So those are some of the easy things that we can incorporate right away that your liver is just going to love you for.

Dr. Eric:

I grind my own flax seeds.

Magdalena:

You do?

Dr. Eric:

Yeah, I have a coffee grinder.

Magdalena:

You’re a different level.

Dr. Eric:

Yeah, and I’m pretty sure a few years ago I wrote an article on phytoestrogens and spoke about the studies…and it’s obviously different than xenoestrogens which we won’t get into here. You talk about those in your book, I think. But yeah, I definitely agree about the flax seeds. And I know you’ve got to go soon as you have another interview coming up. Do you have time for a few more questions?

Magdalena:

Yeah, let’s do it.

Dr. Eric:

Okay, great. So Michelle asks, “Graves and estrogen dominance as well?” Yeah. So whether it’s hyperthyroidism, hypothyroidism, Hashimoto’s, Graves, you can have estrogen dominance.

Magdalena:

Shall we pop the question that we talked about so that we can find a winner for the giveaway?

Dr. Eric:

Okay, so yeah, what question?

Magdalena:

Do you have a question in mind or do you want me to do it?

Dr. Eric:

How about naming one of the three types of estrogen dominance or should we make them answer two of them?

Magdalena:

Yeah, I think one is good. So I talked about two different types of estrogen dominance and so give out the answer for … Give us an example of one of them that I covered.

Dr. Eric:

Okay.

Magdalena:

And the winner is going to be … My team is going to approach you guys and then we’re going to send you a copy of this book.

Dr. Eric:

All right, so.

Magdalena:

Wow, a lot of comments are coming in.

Dr. Eric:

Okay. So for the book giveaway. Yeah, go ahead and name one of the three types of estrogen dominance that we discussed, two of them earlier. And one question while those responses are coming in …There was one about the Mirena IUD, “Can Mirena IUD cause estrogen dominance?” I would say yes.

Magdalena:

Mm-hmm (affirmative). It’s supposed to work locally. And that’s what they tell you. But it’s the better of birth control pills if you will. It’s the lesser of the evil, but put it this way. If you are really struggling with estrogen dominance and you implement, let’s say you follow the protocol from overcoming estrogen dominance and you still are showing a lot of symptoms. Let’s just say five days before your period, your boobs are really, really painful, and you can’t even put on a bra or you’re struggling with your periods.

Then consider removing it. Not every person responds the same way to the same thing. So just honor that. But I think it’s worthwhile for you to hold on to it and make all these different changes and teach your body to metabolize estrogen a really healthy way, support your liver, do an anti-inflammatory diet. By the way, the whole book is based on an anti-inflammatory diet, an elimination-based diet. So it’s free of gluten, dairy, soy, corn. We don’t do nightshade vegetables, all that potatoes, tomatoes and stuff like that is out and is very low in sugar. There are still desserts, but it’s generally very low in sugar. And it completely redesigns your breakfast as well. I’m a big fan of savory breakfast and not sweet breakfast. So you’re going to learn a new way of eating your breakfast, it might change your entire day, maybe your life.

Dr. Eric:

That’s awesome. And let’s see. As far as some of the answers here. So yes, Patricia, this gets recorded. It’s automatically being recorded. And I’ll also be posting this on my YouTube channel as well. Did anybody actually get it?

Magdalena:

Yes, there’s a lot of people saying the right type of estrogen and I think they just mean it’s too high. And so that is one of the correct answers. Not many people got the estradiol to progesterone ratio. Correct. And really what we are looking for you guys is the different, not the symptom, but the different type of estrogens. So that one we’ve mentioned is estrogen and progesterone ratio. But there’s another one that we mentioned that I’ve been talking about.

Dr. Eric:

Yeah, and I guess I could see how they could get confused because there are three types of estrogen, there’s estradiol, estriol, estrone, but we’re talking about there’s three different types of estrogen dominance, not the estrogens itself.

Magdalena:

Should we pop another question?

Dr. Eric:

Okay, yeah.

Magdalena:

I’ve got one and that is name one of the three things that I mentioned that you can really do, start off today or tomorrow to support your liver health. Is that fair?

Dr. Eric:

Yes. I think that is fair. So yeah, one thing you could do to support liver health that Magdalena discussed. And this again is for the book giveaway. And so Jenny asked if you can please post your book information? So again, it is on Amazon of course, you could find Overcoming Estrogen Dominance. What’s your website as well?

Magdalena:

We actually have the book on overcomingestrogendominance.com, it’s available there as well. So that’s the website for now.

Dr. Eric:

Okay, all right. We got a lot of good responses here. Okay, so let’s see. I think it was more clear. I think that they were confused by the other question which is understandable.

Magdalena:

Great answers you guys, you’ve been listening so it’s awesome. Make sure that this weekend you go shopping.

Dr. Eric:

Oh wow, yeah. All right. So how do we choose the winner? Is that up to me or is that up to you?

Magdalena:

It’s up to you, it’s up to you and just let us know … I would suggest to reach out to that person and give them or you can pick now somebody and then ask them to email you their mailing address and then we’ll send the book there. Wow, so many of you got it right, so many good answers.

Dr. Eric:

Oh boy, yeah. This is tough. Let me just do it quickly because I know we’re running out of time.

Magdalena:

You want to do it after we hang out? Because you can do that too.

Dr. Eric:

Okay. Michelle Pilon, “Drinking burdock and dandelion teas, even artichoke.” Does that sound good?

Magdalena:

That sounds perfect. Yes. Artichoke leaf. Yeah, because it’s found in often is that it’s a very bitter herb actually, but it’s great. Yeah.

Dr. Eric:

It was hard to make the decision, but I know I had to just pick and choose. So thank you everyone for your answers. Thank you Magdalena for this interview, this discussion on overcoming estrogen dominance. Again, definitely go to Amazon or go to overcomingestrogendominance.com and pick up a copy of her book. And yeah, thanks again for chatting about this and thank you everyone. Thanks everyone for your questions and participation. We appreciate it. Hope everyone has a wonderful day and a wonderful rest of your weekend. And thanks again Magdalena for chatting.

Magdalena:

Thank you so much.

Dr. Eric:

Bye everyone.

Although it’s common for me to work with patients who have had hyperthyroidism/Graves’ disease for years, I also work with many people who have been recently diagnosed.  And while many of these people simply follow the advice of their endocrinologist, others realize that most medical doctors don’t do anything to address the root cause of their condition. For those people who want to do more than receive conventional medical treatment, I’ve decided to put together this blog post where I’ll discuss ten tips for those recently diagnosed with hyperthyroidism.

Not only do I think those who have been recently diagnosed with hyperthyroidism will find these tips to be helpful, but even those who have dealt with hyperthyroidism for many years will find value in these tips.  This especially true for those with Graves’ disease and toxic multinodular goiter who are tired of having their endocrinologist bring up radioactive iodine and/or thyroid surgery.

Here are the ten tips:

Tip #1: Keep an open mind.  Since you’re reading this blog post you most likely have an open mind.  Perhaps your endocrinologist recommended radioactive iodine or thyroid surgery, yet this didn’t sound like the best option.  Or maybe you’ve decided to take antithyroid medication, but realize that this is only a temporary solution.  Either way I commend you for considering a natural treatment approach.

Tip #2: It’s important to stay safe while trying to address the underlying cause.  This arguably should have been the very first tip, as it’s very important to safely manage your hyperthyroid symptoms while trying to restore your health.  Many people will choose to do this through antithyroid medication, while others will choose natural agents such as bugleweed or L-carnitine.  When I dealt with Graves’ disease I took the herbs bugleweed and motherwort, although many of my patients rely on antithyroid medication such as methimazole.  Since I didn’t take antithyroid medication I can understand others also not wanting to do this, but if the bugleweed didn’t work in my situation I’m pretty sure I would have taken the medication.  On the other hand, if you’re currently not taking antithyroid medication then trying to manage your symptoms with natural agents is an option to consider.  Just remember that the quality and potency of the herb can make a big difference.

Tip #3: Don’t let your endocrinologist pressure you into receiving RAI or thyroid surgery.  While many endocrinologists will recommend antithyroid medication to their hyperthyroid patients, it’s also very common for endocrinologists to tell their patients with hyperthyroidism that they need RAI or thyroid surgery.  Some will even pressure their patients, and might even use scare tactics.  I’m not trying to make light of hyperthyroidism, as there definitely are risks involved.  This is especially true with unmanaged hyperthyroidism.

But I think it’s crazy for endocrinologists to immediately recommend RAI or surgery when someone is newly diagnosed with hyperthyroidism.  If someone is unable to tolerate antithyroid medication I can understand them mentioning these other treatments, as they weren’t taught in medical school to use natural agents such as bugleweed, motherwort, lemon balm, and L-carnitine.  And they certainly weren’t taught to address the cause of these and other health conditions.

Tip #4: If you have Graves’ disease, remember that this is primarily an immune system condition.  This makes it even more ludicrous for endocrinologists to recommend radioactive iodine or thyroid surgery as a FIRST OPTION.  Once again, I realize that there’s a time and place for these treatment methods, but just remember that they don’t address the autoimmune component of Graves’.  Neither does antithyroid medication or beta blockers (or bugleweed, motherwort, lemon balm, or L-carnitine), but the goal of these is to keep the symptoms in check while you find your triggers and correct any underlying imbalances.

Tip #5: If you have toxic multinodular goiter, common causes include problems with estrogen metabolism and insulin resistance.  Your endocrinologist probably won’t mention this to you, mainly because they don’t keep up with the research.  Just as is the case with Graves’ disease, they are likely to recommend either antithyroid medication, radioactive iodine, or thyroid surgery.  And while toxic multinodular goiter can be challenging to treat naturally, I still think it’s worth trying to address the cause of the problem.

Tip #6: If taking a natural treatment approach, start with cleaning up your diet.  Although eating a healthy diet alone many times won’t be enough to restore your health, it still is important.  After all, if you eat inflammatory foods on a regular basis you probably won’t heal.  In fact, even occasionally eating inflammatory foods might prevent some people from restoring their health.  This doesn’t mean that perfection is required, and I definitely haven’t been perfect with the diet since I’ve been in remission from Graves’ disease, but while you’re trying to get into remission you want to do everything you can to avoid gluten, refined foods and sugars, fast food, unhealthy oils, etc.

Tip #7: Stress is a big factor in the development of Graves’ disease.  In addition to cleaning up your diet, another thing you want to do is work on improving your stress handling skills.  Of course if you can decrease the actual stressors that would be wonderful, but this isn’t always possible.  I advise my patients to start with blocking out 5 minutes for stress management EVERY DAY.  While more than this would be even better, it’s important to get into the daily routine of improving your stress handling skills.

Once you are in the routine of blocking out 5 minutes per day for stress management you then can gradually increase the duration.  As for what stress management techniques you should utilize, I recommend some type of mind-body-medicine (i.e. meditation, deep breathing, yoga, tai chi).  Keep in mind that you don’t need to practice the same technique every day.  For example, if you like yoga then you can practice this three days per week, and then meditation the other four days.

Tip #8: Take advantage of some of the free resources I offer those with hyperthyroidism.  I have hundreds of free articles related to thyroid health on my website.  Many of these focus on hyperthyroidism.  Here are just a few of them:

https://www.naturalendocrinesolutions.com/5-hyperthyroidism-diet-tips/

https://www.naturalendocrinesolutions.com/5-precautions-to-take-when-reversing-hyperthyroidism-naturally/

https://www.naturalendocrinesolutions.com/is-hyperthyroidism-causing-your-frozen-shoulder/

https://www.naturalendocrinesolutions.com/5-things-to-know-about-thyroid-eye-disease/

https://www.naturalendocrinesolutions.com/toxic-multinodular-goiter-vs-graves-disease/

In addition, since 2020 I’ve been conducting free thyroid-related events, and by being on my email list you will be notified whenever I have these free events (5-day thyroid-related challenges, Facebook live and Zoom Q & A calls, etc.).

If you’re interested in communicating with others who have hyperthyroidism, you might want to join my “Hyperthyroidism and Graves’ Disease Natural Solutions Support Group”, and attend my regular Facebook live chats (I do them a few times each month on Friday afternoon).  Here is the link to join:

https://www.facebook.com/groups/hyperthyroidtribe

Sometimes I will also do random Zoom calls for those who aren’t on Facebook.  This is yet another reason to be on my email list, as when I do these I will send an email to everyone to let them know the day and time, along with the Zoom information necessary to attend.

Tip #9: Read my book “Natural Treatment Solutions for Hyperthyroidism and Graves’ Disease.  You can find this on Amazon.com, as well as on other websites that sell books (i.e. Barnes and Noble).  Make sure you get the revised 2^nd edition.

Tip #10: Be cautious about self-treating your condition.  Obviously I’m going to be biased here since I’m a natural healthcare practitioner, although keep in mind that I personally worked with someone when I dealt with Graves’ disease back in 2008/2009.  Many people don’t need to work with someone in order to clean up their diet, improve stress handling, etc.  But while improving diet and lifestyle is important to anyone looking to restore their health, doing this alone usually isn’t sufficient.

I do work with people remotely, so whether you live in the United States or in a different country, you might want to check out my Natural Hyperthyroid Restoration and Optimal Health program.  I do require anyone interested to 1) watch a free webinar and 2) complete a brief online application, and if you want to watch the webinar you can Click Here.

Bonus Tip: Check out the Save My Thyroid podcast.  This podcast is specifically for people with hyperthyroidism, and as the title of the podcast implies, the main goal is to help people save their thyroid gland…while addressing the underlying cause of their condition.  Click Here to listen to the episodes on my other website, and if you have an iPhone and want to subscribe Click Here.  If you have an android and would like to subscribe Click Here.

I’ll wrap up this blog post by mentioning that whether you have Graves’ disease, toxic multinodular goiter, or a different type of hyperthyroid condition, it is possible to regain your health and avoid radioactive iodine and thyroid surgery.  I’m not saying it’s an easy process, as it will take time and a commitment on your part.  But in my opinion it’s well worth the effort.

Have You Been Recently Diagnosed With Hyperthyroidism?

If you have been recently diagnosed with hyperthyroidism I’d love to hear from you!  Have you seen an endocrinologist?  If so, what was your experience? Did you know you wanted to take a natural treatment approach immediately after being diagnosed with hyperthyroidism?  Or did you have no idea that natural treatment methods were an option until you did some searching?  Thank you for sharing your experience with everyone!

On Friday March 5th I interviewed Dr. Amy Day, founder and CEO of the Women’s Vitality Center, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric:

Hello, everyone. Hope everyone is having a wonderful Friday so far. With me today is Dr. Amy Day. Dr. Amy has been at the forefront of the natural woman’s health movement since 2004 after receiving the fourth ND license in a State of California. So while she was in naturopathic medical school, struggles with her own women’s health issues fueled by Dr. Amy’s passion. So pretty much in short, Dr. Amy’s a hormone expert, so that’s why we’re going to chat about adrenal health, perimenopause, and we’ll also be answering some of your questions later on. She’s the founder and CEO of the Women’s Vitality Center. She specializes in helping busy professional women struggling with perimenopause to balance their hormones. A big part of that is also balancing their adrenals, which we’ll get into. Welcome, Dr. Amy, thanks for getting together for this interview.

Dr. Amy:

Absolutely. It’s an honor to be here, and it’s really been fun to connect with you and get to know you and all the amazing thyroid work that you do. It’s so important how all these different hormones interconnect with each other, and I’m excited to have a conversation about it today. Thank you for having me.

Dr. Eric:

You are very welcome, I’m excited as well. Why don’t we just jump into the adrenals. We’re going to, again, talk about adrenals and perimenopause, and I think Dr. Amy might’ve froze there. Dr. Amy, are you still with us here?

Dr. Amy:

I’m still here.

Dr. Eric:

Okay, as long as we can hear you, so your screen’s freezing a little bit.

Dr. Amy:

Okay.

Dr. Eric:

But no worries. We’re going to start talking about adrenal health, and then we’ll make our way into perimenopause. Can you tell the viewers why the adrenals are so important for our health?

Dr. Amy:

Yeah, so adrenals, many people have heard of them and many people have not. So just to take a little step back of like what are the adrenals? What are we even talking about? The adrenals are a part of our endocrine or hormone system that they have many functions. But one of their main functions is to help us to respond to stress. They’re little glands that sit on top of your kidneys in the middle of your back, they’re like little hats that sit on top of your kidneys and they produce cortisol, which is your main stress response hormone. They also produce a host of other hormones, but that’s one of the big roles for the adrenals. This all has to do with how do you respond to stress? Stress is going to happen in life, so how is that working for you physiologically to be able to respond to that stress?

Dr. Eric:

Thank you for that explanation. Why do so many people have adrenal problems? At least, I see a lot of adrenal problems in my practice and I assume you do as well?

Dr. Amy:

Yeah, absolutely. It’s interesting what we consider to be an adrenal problem. In conventional medicine, there’s this black and white picture of everything’s completely fine, or you’re in a completely diseased state of the adrenals. What we see in more functional medicine, natural medicine practices is everything in between, where the adrenal glands are just having dysfunction related to the chronic stress that we tend to accumulate in our lives. Whether it’s big, short-term stresses that are going on or all the little things that add up over time and are going on for a longer time, that accumulation of stress can make it so that the adrenal system is just not able to completely respond as adequately.

One other thing to mention about what the adrenals do for us, there’s a stress response in the sense of like, in the moment, there’s a stressful thing going on and you get your blood sugar up and your heart pumping and your eyes dilate and your muscles are stronger. You’re flooding your system with blood sugar to be able to fight or flight, so there’s that acute stress response. Then there’s also a role, a really important role that the adrenals do for us, which is regulating the circadian rhythm or our 24-hour clock. Your adrenals produce cortisol for you first thing in the morning, that’s part of your get up and go.

Then those higher levels taper off over the course of the day and drop at nighttime, so regulating that night/day rhythm is another really important thing that the adrenals do. When we’re in chronic stress situations, when our schedules are irregular, when we have an acute issue of something going on, either emotional or physical, any of those things can contribute to the challenge of the adrenal glands.

Dr. Eric:

Okay, great. It’s important what you just said, as it’s not just emotional stressors, but physical stressors, and lack of sleep also have a huge impact on adrenal health. You also mentioned difference between acute stressors and chronic stressors. When someone is in acute stress, the adrenals do a pretty good job of adapting to acute stress, so you’re more concerned about the chronic stress, correct?

Dr. Amy:

Yeah, either the buildup of the chronic stress or the long-term impact of the acute stresses when they happen. Some people, they’ve never been well since some big thing happened in their life or to their bodies or something, and then it’s the long-term consequences coming from that. Because that resiliency wasn’t there to be able to bounce back. That’s how acute stress can turn into a long-term issue or the chronic stress, that’s the every day grind of all the demands in our lives and the get up and go, and the deadlines, and the world that we live in, and the issues that different people face that are just constant drains on our system.

Dr. Eric:

Yeah, and of course it’s only been increased over the last year for a lot of people with everything going on. But even before last year there’s always been stressors, there’s always going to be stressors, and that’s why we want to try to do everything to improve our stress handling skills. We could talk more about that. But I want to talk about, of course, thyroid and adrenals. As far as stress, stress affects adrenals, so what is impact that chronic stress has on thyroid?

Dr. Amy:

I’ll make a couple comments, but I’d love to hear from you, so there’s connection.

Dr. Eric:

Sure.

Dr. Amy:

So often we see when people are having thyroid problems, that there is an adrenal aspect to that also, or it could be vice versa. I see it a lot in practice and we know that in order for the thyroid to function optimally, that the adrenals need to be functioning optimally as well. But I turn it to you, I would love to hear your perspective actually on how that relationship is between the adrenals and the thyroid.

Dr. Eric:

Sure. There’s a few different ways. Especially, when someone is dealing with a chronic stress and high cortisol. T4, as you know, converts into T3, which is the active form of thyroid hormone. Most of this takes place in the liver, some of it takes place in the gut, I think approximately 60% in the liver, 20% in the gut. Those could have an impact on thyroid health. But also when someone has stressed out adrenals, that could affect conversion of T4 to T3, especially when they have high cortisol levels. So a lot of times we’ll see, or I’ll see normal T4 and low T3.

Again, this might be related to problems with the liver, or it might be related to problems with the gut.  So it’s not only adrenals, but adrenals can play a big role. Then chronic stress, for those with Graves and Hashimoto’s, chronic stress causes dysregulation of the immune system, which is a pro-inflammatory state. That could also be a contributing factor, or potentially, a trigger of thyroid autoimmunity. Then another way is there’s what’s called Secretory IgA, which lines in mucosal surfaces of the body, and chronic stress will typically decrease Secretory IgA. That’s a protective barrier, so when you have a decrease in Secretory IgA, it can make you more susceptible to, let’s say, infections, for example.

So those are three different ways in which problems with adrenals can affect thyroid.  One directly affects thyroid, the other ways affect the immune system. But, yeah, I definitely see a lot of that in my practice as well. How about sex hormones? Because, again, we’re going to talk about perimenopause, so do you want to talk a little bit about the impact of stress and adrenals on sex hormones?

Dr. Amy:

Yeah, definitely. I love the points that you just made too, it just speaks to whether we’re thinking of it as an adrenal problem or thinking of it as a thyroid or thinking of it as a sex hormone imbalance, wherever it’s showing up like that, just recognizing that the stresses are showing up in our bodies in all these ways. I feel like in our society, it’s become so normal to just be experiencing stress all the time, and that idea of really recognizing it’s having a huge impact in the idea of how stress is, basically, is detrimental to our physiology as smoking is which we pretty broadly now know most people don’t want to be doing that to their bodies. And yet, we have a lot of stress in our lives and there’s a lot of reasons for that, so it can be challenging.

But, anyway, thank you for pointing out those different aspects of how the adrenals are impacting the thyroid, for sure. The impact on the sex hormones, so the adrenal glands, I mentioned earlier, they produce cortisol. They also produce a host of other hormones. They are actually capable of producing estrogen and progesterone too. So part of what happens in perimenopause is that your ovarian production of estrogen and progesterone start to change. First, women tend to start producing less progesterone and still have the estrogen on board. But then later through the perimenopausal transition and into menopause, then having low levels of both progesterone and estrogen is a typical course for that.

The adrenals are able to produce some estrogen and progesterone, which can help to fill in the gaps, if you will. Stabilizing during perimenopause when the hormones are just on this roller coaster of crazy ups and downs that can be stabilized out, and then postmenopausally, that the adrenals can contribute to the hormones that are missing at that time.

Dr. Eric:

All right. One thing also I’ll mention is that… I don’t want to get too much into the hormone pathway, but it all starts with cholesterol. You, of course, you need healthy cholesterol. If you’re taking something like a statin then that can also affect sex hormones. Then cholesterol turns into pregnenolone, and then it separates into two different pathways. The body will always prioritize the production of cortisol at the expense of the sex hormones. Which makes sense, if you’re in a stressed out situation, you’re probably not going to want to have sex… Like an example of going back to the caveman years where if a caveman was being chased by a lion, or I guess that could happen today too maybe, being chased by a bear or something, you’re not going to want to have sex while being chased by the bear.

You’re going to think about just the fight or flight reaction, so the body’s going to always prioritize cortisol. But the problem, again, as we’re discussing, everybody’s in a chronic state of stress and so they’ll always be pumping out cortisol. That’s going to sacrifice the sex hormones, DHEA is going to be on the lower side, testosterone, the estrogens. You might not see all the hormones low because it takes time for that to happen. We’ll talk about the testing as well, especially, more so with the adrenals. But, yeah, why don’t we jump into perimenopause and talk about… or why don’t we talk about, maybe, talk about testing a little bit and lead into that? Because you do recommend testing the adrenals, is that correct?

Dr. Amy:

I do. It’s interesting, a lot of women will start experiencing some changes. They’re in their late 30s, going through their 40s. For some women, it’s not until their late 40s that it’s really starting to kick in anyway. But just what perimenopause usually starts with is subtle or sometimes not so subtle. But sometimes we’re like not sure, “Is this perimenopause? What’s going on? I’m a little hotter than usual, or my period came late, or I’m snapping at people more often.” No, it’s just because the people are really annoying now, or maybe my hormones are changing. That’s all the different changes that can happen, and we start putting the pieces together like something’s going on here. A lot of women are coming with the question of like, “I want to get my hormones tested. I want to see what’s going on.”

Something that I think is important to know is that there can absolutely be value in testing the ovarian hormones, the estrogen, progesterone, the testosterone…actually measuring and looking at those. But very often the estrogen and progesterone are shifting and changing day by day, and even from one cycle to the next. Timing that testing and really interpreting it can be a little tricky. You can definitely get useful information from it. But most conventional doctors, when I’ve had patients say they went to their doctor, they asked for testing, and the doctor says, “We don’t do any testing.” I think it’s important to know that there can be useful testing to be done. But the first layer of testing that I always recommend is a general screening blood test and adrenal test.

In the general screening blood tests, and that this is going to be… you mentioned a minute ago the sex hormones and adrenal hormones are made from cholesterol. Are you getting enough good fats in? Do you have cholesterol? We’ve been told for heart health reasons, you don’t want high cholesterol, you want to keep your cholesterol really low. But you actually need enough and you want to be getting in those good fats and having that cholesterol as the precursor to your hormones. Screening things like cholesterol, heart health markers, your blood sugar regulation markers, nutrient levels. Things that might explain if you’re feeling tired, if there are things going on in your body that you want to check in on. Thyroid, of course, really important to do a really thorough screening.

Even if you’ve had thyroid testing done before, this is a time in life where because everything’s up and moving and changing a little bit, this is a time where it can show up, even if you’ve been normal in the past. A really good thorough thyroid screen, which I can leave you to chat about. Then the adrenal testing is in looking at your cortisol over the course of the day to see how your production is doing for the adrenal glands, the cortisol, and the DHEA can be really important to look at. That you’re going to get more useful information out of as a first layer, and usually addressing those, the nutrition and the thyroid and the adrenal and the blood sugar regulation, that will create a foundation of stability that helps to decrease the wildness of the up and down roller coaster that perimenopause can be.

Dr. Eric:

All right, thank you for that. With regards to adrenal testing then, I know we chatted a little bit before this interview, so I know, just like I do, you do saliva testing and you also do some DUTCH testing. We’re not going to get too much into the dried urine testing because it is a pretty in-depth test. I guess I could ask you, we both know the answer to this, but of course we’re testing the viewers. Why would you want to do a saliva test, or dried urine test and not just test morning cortisol in the blood?

Dr. Amy:

Yeah, good question. Let’s see, so because of the fact that the adrenals are regulating your circadian rhythm and that 24-hour clock, your cortisol changes throughout the day. It’s a lot like when we’re testing estrogen and progesterone and a woman having a cycle, it matters what day of the cycle we test on because the levels are changing. A level on one day might look low and other then it might be high, but it’s the same number. You have to know what you’re looking at, and the way that cortisol has its cycle in a day, we produce more cortisol first thing in the morning, and then it tapers off as you go through the day and drops at nighttime to help you wind down and go to sleep.

You need to look at that pattern. By looking at only one data point, you’re really not getting a full picture of how the adrenals are responding over the course of the day. Then a blood level is a very short-term, that’s just the amount that’s circulating right in that instant. For some people getting their blood drawn is a stressful experience.

Dr. Eric:

Yeah, I was going to bring that up. I’m glad you did.

Dr. Amy:

In order to get a blood draw, unless you happen to have a partner or someone in your home who’s a venipuncturist, usually, you have to be up and get ready and get out the door and go somewhere to get your blood drawn. Your cortisol peaks about 15 to 20 minutes after you first wake up. So getting that awakening response and getting a sense of what’s happening right away in the morning is more indicative of your cortisol level. There are several factors that make a home test kit, and there’s pros and cons to saliva or a dried urine testing.

But both of those give you the opportunity to test at home and look at four different points, at least, over the course of a day and map out that pattern that gives you an idea. It’s not just am I high, am I low, it’s what’s the pattern over the day? Is what really is what we’re looking for.

Dr. Eric:

Yep, correct.

Dr. Amy:

Did I get all your points? Did you have anything to add?

Dr. Eric:

I think you hit it all with regards to, especially, cortisol. As you mentioned, there’s no perfect test, and a big potential drawback of the blood test is, like you said, a lot of people… even if they’re not stressed out, going to the lab, just getting the blood draw itself for some people, they might not perceive it as being stressful. I know it does come down to the perception when it comes to stress a lot of times. But that’s also important to mention, even when doing a home test. Like saliva or dried urine, you want to collect it on a regular day, and ideally, a lot of people will do it on a weekend just because it’s hard to do during a work day.

But the point is if you have an abnormally stressful day, so if you’re collecting it and you have an argument with your spouse before the collection, or have a headache. I’ve had a lot of people with different patterns, but I remember one specific situation where someone did their saliva test and I saw that it was elevated around lunchtime and they were mentioning that they were studying for an exam and they were stressed out because of the exam. Again, even though the home tests aren’t perfect, and that’s why if I see some crazy findings, I usually ask the person, “Did anything unusual happen that day?”

But, yeah, it’s the same exact reason I’ve been doing saliva testing all these years, and more recently on some people I’ve done dried urine testing. If you’re just focusing on adrenals, I think saliva testing or dried urine testing is fine to do. Yeah, just for that circadian rhythm, so you could see it throughout the day, first thing in the morning and then last thing at the end of the day. Then a couple of samples in between. Thanks for that explanation.

Dr. Amy:

Yeah, should we talk a little bit about the patterns and what that can mean?

Dr. Eric:

Yeah, I think that’s a good idea because also some people wonder why test the adrenals? We’ll get into the patterns and that’s a big reason why. But, yeah, if everybody’s stressed out, why don’t we just assume people have adrenal problems and not do the testing. It’s because different people have different patterns. I’ll let you take over and talk about some of the different patterns.

Dr. Amy:

Yeah. It’s interesting that you put it that way because you’re right, there is this idea that like I know I’m stressed, I know that’s part of it, so why does it matter? What’s going to change based on the numbers or the patterns? To some extent, it’s a valid point to make. If you’re really watching your budget or really trying to just take the most streamlined approach to what you’re doing for your health, if you’re willing to make some lifestyle changes and you don’t necessarily need that data to prove it to you, it’s a lot of the things that help to restore adrenal function are safe and appropriate to do regardless of exactly what your numbers or your pattern really is.

There’s some truth in there, but you can get more specific if you know exactly what’s going on in your own physiology. You can put your effort more focused on the things that your body particularly needs. If you know better where you’re starting from, and the truth of the matter is that for most people actually seeing it on paper is just so, or on the screen if you’re looking at electronic results, it’s validating for one thing. Your other doctors have probably told you, “Everything’s fine. There’s no reason for you to be so exhausted. It’s all in your head,” or whatever. That validation of like, “Yes, there is a real thing going on with you here.”

It gives you a baseline that you can compare to in the future too. You can see, “Okay, I’ve made it this far in my progress at three months or six months,” and you know how to monitor that too. There’s three basic patterns that I usually tend to find.  Of course, every individual is unique and there can be nuances in this. But there’s the people who just like run high. The normal slope might be like this, and they’re just across the top of the chart like this. This is someone who’s probably experiencing anxiety, wakes up in the morning, early on, ready to go, jumps into everything, like, go, go, go, go, go. Mail them in, and ends the day still just powered through and all that.

So some people just run high. Some people run low. This is so hard to get up and get going in the morning that maybe the alarm goes off and you snooze it six times, and you’re dragging yourself out of bed. And try to pry your eyes open and maybe feeling like you have to have caffeine or sugar to get your engine running and get yourself going as you go through the day dragging, foggy thinking, hard to do your work. You get to the end of the day and just like, “Ugh, it’s so just been bottomed out all day long.” Then the other third pattern that’s probably the most common that I see, because it’s the in between point, is a reverse curve. Where you’re tired in the morning, you’re trying to get going. It takes a little while to get it all going and all of that.

You’re tired through the day, a little foggy, maybe some ups and downs. If you’ve got something exciting you’re working on, and then you get to the end of the night. The classic description of this is wired tired, where you get to the end of the night and you’re wishing you could sleep, but boing, everything turns on. Your eyes are wide open and you’re so productive and you’re getting your stuff done, and you’re doing all these things. You finally have this burst of energy and this time maybe late at night, and then you end up going to bed late, and then the next morning you’re tired and the whole pattern keeps repeating too, so the reverse curve. Usually, the order of things over a person’s lifetime is that we can run high, high, high, and go like that for a while.

Then the system starts dysregulating and flips, and then ultimately burnout is that low, just I can’t even mount that response anymore. That’s what we’re looking for on the test results is where are you in at different times of the day to show where you need to focus the most on to help correct the curve and help support the adrenals.

Dr. Eric:

All right, wonderful. Also, we want to let viewers know that we’ll be answering questions soon, so if you have questions for Dr. Amy or myself, just type in the chat and we will get to them. You made some good points, so when I was dealing with Graves’ disease, at that point, I knew stress was a factor, but I honestly didn’t think my adrenals were too bad. I was one that needed validation to get the testing. But I will say this, you can’t always go by symptoms because someone listening might say, “Well, I’m fatigued all day, so I know my adrenals are low.”

But sometimes that’s not the case, sometimes someone will be fatigued yet they might have an elevated cortisol levels. In my situation, I didn’t feel fatigued yet everything was low. I had low cortisol, low morning cortisol, low DHEA. Pretty much everything was low on the test and I felt fine, and probably a big part of that is because with hyperthyroidism you get the increased metabolism so that was offsetting it to some extent. But, yeah, so if I had to guess before that, I would have guessed that either my adrenals were normal, because again, I was in denial, or I would have said if they were out of balance, I would have guessed they might’ve been on the higher side. I would have never guessed they would have been low. That could, to some extent, dictate the treatments.

Obviously, you could, regardless of whether or not you do adrenal testing, you could eat well, you could do meditation, yoga. It’s not like you can’t do anything, but for certain adrenal patterns, you might want to. In my case, again, my adrenals were low, so I took licorice root to help with lower cortisol. If someone has elevated cortisol, they might take phosphatidylserine. You might have other suggestions, and those are just some general… Well, not general, but general based on the pattern. Licorice I would say, if you have high blood pressure, you would not want to take it. Be careful with certain herbs and supplements. But let’s go ahead now and talk about perimenopause.

Dr. Amy:

I just have one other question on testing before we go ahead.

Dr. Eric:

Oh, yeah, sure.

Dr. Amy:

Can you walk us through what you would recommend screen? Because you’re talking about screening is important, right? You can’t always tell based on your symptoms. Your energy could be high or low for so many different reasons, so the screening and looking at these different pieces and figuring out, “Okay, which of these is the biggest factor for this person?” What do you recommend for thyroid screening?

Dr. Eric:

Yeah, so thyroid definitely, of course, TSH or our friend thyroid stimulating hormone, which probably is one of the least important. I still pay attention to it, but a lot of doctors, that’s all they do, is TSH. TSH, I like looking at the free hormones, free T3, free T4. If someone wants to do a full panel where they’re looking also at the total T4, total T3, that’s fine too. But, usually, I stick with TSH, free T3, free T4, thyroid antibodies. It also depends on the presentation of the person. If someone comes in, what I’m suspecting to be Hashimoto’s usually it’ll be antithyroglobulin antibodies and thyroid peroxidase antibodies. If they have Graves, the antibodies specific for Graves are TSI, thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody.

There’s also reverse T3 that could also play a role in conversion. A lot of times you’ll see reverse T3 high if someone has a problem converting T4, T3. The only thing is in hyperthyroidism, I used to do it on all my patients, but in hyperthyroidism, most people have everything high, including reverse T3. I usually don’t recommend it anymore for my hyperthyroid patients. From a thyroid perspective, that’s what I write. Then, of course, the basics like CBC with differential and all. But you just asked about thyroid, but there’s other blood tests. Are those what you do?

Dr. Amy:

Yeah, that’s what I do. The reverse T3, that’s interesting to make that point that you just did. I usually do like to look at it at least on a first layer screening. Because more often the people that I’m interacting with are tired and fatigued, and I’m worried about that conversion or if the adrenals where they got to the liver are playing into that. But it makes a lot of sense if someone is hyper, they’re just going to be high across the board. You’re not really looking at conversion in that instance, it’s more just like everything’s just high for the T3, T4, reverse T3, all of it.

Dr. Eric:

Exactly. All right, so why don’t you talk about perimenopause? What’s the difference between menopause and perimenopause?

Dr. Amy:

Yeah, good, good, good. The technical definition of menopause is when it has been a full year since your last period. It’s defined that way because in the time leading up to menopause, sometimes women will go a long time in between the periods, but then it’ll still come. It’ll be, instead of a month, it’ll be two or three months or five or six months even. Then it might stretch out to like seven or eight months in between periods. But once you’ve gone a full year, it’s pretty unlikely that you’re going to get another period again after that. That’s long enough to say like, “Yeah, your body is done with having periods.” It’s a defining moment, it’s a single day, it’s been exactly a year since you had a period.

I always like to joke and recommend like throw yourself a menopause party on that day. It’s been a year. Then after that day is technically referred to as postmenopause, and then what we’re talking about, especially today, here today is the whole transitional period leading up to the actual moment of menopause when it’s been a year since that last period. There’s a whole stage of life, of transition, and I like to give the visual of thinking about your menstruating years as a bell curve. When you have puberty, when you’re in puberty, when you’re a young teen, unfortunately, it’s happening earlier these days, but usually a young teen first period to start the menstruating years. There’s an on-ramp and we call that puberty and that’s the whole teenage timeframe of body changes and moodiness and questioning who am I really anyway? Like refiguring your life and feeling awkward and having these changes going on.

Then as we get into the 20s and 30s, there’s more stability, and more like the top of that bell curve. For most women, there’s always exceptions. But just in the normal curve of things is pretty regular cycles, and usually, this is the more fertile years and just more stability and regularity in the menstrual cycle. Then there’s the downside of the bell curve. As we taper down, it’s basically what I like to help people think about perimenopause. It’s like puberty in reverse, so it’s a very similar experience where your body is changing and things are going on and you might be feeling moody and all those kinds of things. But the beauty of perimenopause is that you’re older and wiser and hopefully have more resourced in your life and in your experience and in connections and how you can get help if you need it too.

It’s not a disease, it’s not something that needs to be overly medicalized. But it’s a natural life transition and it can be a little ambiguous to define as puberty can be too. At what age does puberty end? There’s no real exact notion to that. When does perimenopause begin is a little loose like that also. As soon as there’s some shifts or changes or things that just aren’t as stable as they had been before, that’s probably the beginning of perimenopause. It can last five, up to 10 even years. It doesn’t mean that you’re going to be menopausal in any moment here, it’s just it’s a phase, it’s a transitional time. There’s a lot that you can do to help support the journey through it all.

Dr. Eric:

Okay, so there are no specific tests for perimenopause?

Dr. Amy:

There’s not an exact test for saying that perimenopause has begun. We can start to see FSH and LH start to rise, but it’s not a direct trajectory. When you’re in your menstruating years, usually, LH and FSH will be lower when you’re postmenopause will be higher. But there’s not a direct line. In perimenopause, it can be all over the place, so you could be high one month, low another month. It’s not an accurate way to assess, and your estrogen and progesterone levels can be changing. But, again, there’s no like no number of high or low because they’re changing. Yes, there’s no exact tests that defines you as perimenopause.

Dr. Eric:

Okay, so what’s the most important thing for a woman to do to help herself have a smooth transition through perimenopause?

Dr. Amy:

Yeah, so that’s the first half of our conversation really is the answer to that question. Really hoping that stabilizing that foundation, and that’s addressing the stress boosting the adrenal resiliency, so that stress isn’t having such a big impact. Getting your nutrition on board, your blood sugar regulated, your thyroid really functioning well. All of that builds this foundation that makes it a much smoother ride. There may still be some ups and downs, but I like to joke that without any of that support in place, perimenopause can be like the thrill seeker roller coaster that’s like woo, up and down, it’s scary and really intense.

But with that stable foundation, we can put you on the little kiddie roller coaster. It’s just there may still be some ups and downs, but you can ride with it and have a good time with it. That’s building that foundation and really I’ve seen that all of those factors are important and I’ve just seen again and again, that the adrenals and the stress that underlies all of those is so much of what makes the difference.

Dr. Eric:

All right, all right, very good. Well, I definitely want to leave some time for questions, and then we’ll also talk about your quiz. Dr. Amy has a quiz that she’d like to share. But is there anything else you’d like to add?

Dr. Amy:

I think just the point, I feel like when we talk about stress and the fact that stress can lead to all these other issues that I just want to be careful to say that it’s not that you have to completely remove yourself from stress or from your life in order to be healthy. I think that it can be easy to go into the extreme of like, “Oh, well, I have to completely change everything and stop doing all these things and all of that in order to get stress down.” I really see it more as how to build your resiliency and how to help your body and your physiology be able to be healthy in an environment that has stress going on in it.

Because a lot of the women that I work with are leaders, entrepreneurs, business owners, or have projects that they’re working on. They have their families that they’re supporting and everything. I think it’s really important that women can do the things that they want to do and have their impact and make their difference and it’s important to have your health supporting you to be able to do all those things too, and that is possible. I’ve been through it myself, up and down, where I get so into something and then I get sick and adrenal fatigue or whatever and I have to build back up again and then that. I’ve learned in that process of figuring out the things that help to keep that stability in place while being able to continue pursuing your passions and doing the things that you want to do.

And having your health really making it all possible instead of your health suffering because of all the things that you’re doing. Just wanted to make that point. Stress can be a good thing, it’s about the skills you mentioned before, are stress supporting skills and how we help our physiology to be able to roll with the things that go on in life.

Dr. Eric:

Wow. Thank you for adding that. I am going to put the link to the quiz, but I’d like you to talk about the quiz so people when they see, why should people go ahead and take your quiz? I’m going to recommend, definitely take the quiz.

Here is the link to Dr. Amy’s Quiz:

https://replenishyourenergy.com/quiz​

Dr. Amy:

Yeah, so the quiz it’s called the why am I so tired quiz. This is something that I just hear from so many women and just being able to get a better understanding about what factors are at play and why you’re feeling so tired all the time and what could be going on that’s going to help you? That idea that stress is inevitable, but if you’re feeling depleted, you’re feeling rundown, you’re feeling the effects of that chronic stress build up, why is it that that’s happening? After you take the quiz, then we’ll talk more also about how to build your resiliency and how to help to get you to a place where you’re having more energy too for all the things that you’re doing.

When you take the quiz, you’ll get your resiliency score, so you’re going to find out how your adrenals are doing and this is just how much of a factor stress is being for you and your particular case. I’ll give you some tips on getting started boosting your energy. I, also, am going to be teaching a workshop later this month called From Fatigued to Fired Up. I’m going to be teaching some surprising strategies in there about the kinds of things that can make the difference to really help make a shift and help to build your resiliency and boost your energy and help you to be able to make your difference and really enjoy your life and do the things that you want to do. But have your health really supporting you in doing that. Start with the quiz and find out why am I so tired? I hope that will be helpful for you.

Dr. Eric:

Great. Then when they complete the quiz, they’ll get information on that masterclass if they want to sign up. Is that correct?

Dr. Amy:

Yeah.

Dr. Eric:

Okay.

Dr. Amy:

Yeah, when you complete the quiz, you’ll get your number. When you click on that, you’ll get some tips, some information of understanding that. At the bottom of that page, there’s a button right there to sign up for the class. Then go through and actually sign up for the class and we’ll make sure that you get your free access to that. If you miss it on that, we’ll send you a follow-up email to make sure that you know when that class is coming. It’s a few weeks from now, but you can reserve your spot now and we’ll send you reminders as it gets closer too.

Dr. Eric:

All right, wonderful. I have it on the screen here. I put it in the chat. Now, it’s not going to go into the Facebook groups, so I’ll have to do that manually, which I’ll do that just because it’s a private group. I’m thinking it’s just going to the page right now, but I also have been displaying it for the last minute or two here. I’ll make sure that I’ll manually put it in the groups, and all right.

Dr. Amy:

If anyone’s listening and didn’t see that typed, it’s just replenishyourenergy.com/quiz. So replenishyourenergy.com/quiz.

Dr. Eric:

All right, cool. Thanks for verbally letting everyone know. Yeah, definitely, sign up for that quiz and as well as the master class. Which again, the masterclass will be later this month, but the quiz you could do right away, or maybe in a few minutes after we answer questions. But, all right, so let’s get to… Stay in your lane. Hello, Dr. E and Dr. A, happy Friday. Thanks for sharing. You are welcome, thanks for attending.

Dr. Amy:

Happy to be here.

Dr. Eric:

We’ve got someone from Facebook watching. That’s the only downside of StreamYard is if they don’t give permission, then their name doesn’t display. That means they’re in the group if it comes up as Facebook user. “I’ve been the reverse curve for all my adult life, and I was told it was because of my low blood pressure, 120 over 60. I developed Graves five years ago, and it got down to five milligrams after beginning toxics. Are you talking about the medication five milligrams? Because I know a lot of patients take methimazole and five milligrams would be like a low dose. Because I don’t think a blood pressure of like 120 over five, that would be like pretty low.

Dr. Amy:

I think they’re saying that they probably started treatment five years ago. They’ve had improvement, they’ve gotten the medication down.

Dr. Eric:

I’m joking. I’m just cracking an unfunny joke here. What would I do to improve the cortisol? Well, I’ll let you, I could always add, but let’s hear from you, Dr. Amy.

Dr. Amy:

One thing that strikes me is I just want to question and reverse the cause and effect or the chicken and egg part of your first comment of having that reverse curve and saying that was because of low blood pressure. I would actually say that more than likely the imbalanced adrenal function is contributing to your low blood pressure. The adrenals, I mentioned early on, they produce a host of hormones. Cortisol is a big one we talk about that has to do with the stress response, DHEA, another important cortisol hormone. They can produce estrogen and progesterone we talked about. Another hormone that the adrenals are responsible for producing is one called aldosterone, which is more to do with regulating your fluid and electrolytes and regulating the kidneys.

So remember the adrenals are actually located on top of the kidneys and there’s a reason for that. Because they actually do regulate the mechanisms of kidney filtration. When the adrenals are not functioning properly, we tend to lose our electrolytes more easily through the urine. And that can cause us to feel low blood pressure because we don’t have that salt and the electrolytes in the bloodstream to hold the fluid in. Then we can get low blood pressure, and a lot of people with adrenal dysfunction have low blood pressure, feel like you get dizzy. If you stand up too quick, you’re going to get dizzy or faint easily. So really supporting, I’d say, one of the first things if you’re having low blood pressure and you’re needing to support your adrenals would be to make sure you’re getting plenty of electrolytes in.

One thing that I recommend for people to start your day, as long as you don’t have high blood pressure and need to watch your self intake, start your day with a glass of water, with some salt in it. It’s a really nice way to start your day and a little squeeze of lemon if you’re inclined to that. But the salt or the electrolytes, first thing in the morning, help to get the adrenals going and help to make sure that your body has that support for the blood pressure. Electrolytes can make a really big difference, and lots of other things that help to stabilize and flip that curve back to being high in the morning, low at night. There’s a lot to that. But one of the first things when I hear that blood pressure piece would be electrolytes.

Dr. Eric:

Yeah, and you would recommend natural sea salt, for example?

Dr. Amy:

Yeah, so either the natural sea salt, Celtic salt, Himalayan salt, and any of the good quality salts that have some minerals with them too. In terms of the amount, it varies to taste. Usually, when this is going on, people will also actually crave salt too. If you do, the person who wrote this in, if you also notice yourself having cravings for salt through the day, then this would be probably really good for you to do. That you put salt to taste, so it should still taste good. It should be like refreshing. If you feel like you’re drinking ocean water and it’s disgusting, then cut the amount of salt back.

What usually happens over the course of a few months is the same amount of salt that you were craving and wanting suddenly starts tasting too salty, and you can decrease the amount that you’re including in your morning water.

Dr. Eric:

All right, thank you for that, Dr. Amy. We’re going to go another question…

Dr. Amy:

And congrats on the improvement so far with the Graves like just to be able to get down to that really low dose and it’s good progress moving in the right direction. I think addressing the adrenals next could probably be really helpful for you.

Dr. Eric:

Yeah, no, that is true. Five milligrams, low dose. Obviously, once it gets to the point where you don’t need the methimazole, but, yeah, one step at a time.

Dr. Amy:

Are there things that you’ve seen, Dr. Eric, that have made the difference for someone to get off that last little bit? To get them to the place where they really don’t need it?

Dr. Eric:

Yeah, probably too much to discuss here because it’s not just the adrenals. Adrenals do play an important role, and like I said, I had a low cortisol pattern the morning. I didn’t have a reverse curve, meaning my cortisol wasn’t high at night. But I had low morning cortisol, and of course, diet lifestyle factors played a big role. Then other things, I mentioned a licorice root in my case, which again, we can’t give specific recommendations here. Since you have low blood pressure you might be fine with that. But, again, in my case, that helped out, B vitamins, vitamin C. Nutrients overall are obviously important. But there could be other things, of course dragging down the adrenals as well.

It could be stealth infections, and again, not saying that’s the case with the person who just asked a question.  I definitely would follow advice of Dr. Amy, or suggestions that Dr. Amy gave. But try to do everything you can diet lifestyle. But sometimes, actually, a good number of times we do have to dig deeper, especially, if diet and lifestyle isn’t enough. If you’ve been dealing with it for a long time, then you might have to dig deeper. Could be, again, like I said, infections, it could be toxic mold, it could be chemicals, environmental toxins. But, yeah, good job so far getting down to the five milligrams.

Maybe just by improving the adrenal health itself, you might not need to dig deeper, or you might have the answer. As Dr. Amy said, it’s not always just emotional stress. We all deal with stressors, a lot of times we could just do things to improve our perception of stress. Again, blocking out time for stress management, mind, body, medicine. But, as I mentioned, sometimes we do need to dig deeper. All right, we got Claire. Thanks for joining Claire. Claire says, “I love the concept of puberty in reverse.”

Cool, cool. Cool. All right, and then I could answer this. “I have hyperthyroidism, is a good for me to go for surgery?” Again, I can’t give specific recommendations. All I could say is that sometimes surgery is necessary. I can’t say it’s never necessary, but in most cases it should be the last resort. It really depends on the situation.  If someone has thyroid cancer, for example, that might be a situation when surgery is necessary. My goal is to try to work with people to try… just like I did, when I had Graves, I could have opted for radioactive iodine and thyroid surgery. I chose to address the cause of the problem.

Everyone is different and there’s a time and place for surgery, but my goal is to try to minimize people getting the conventional medical treatment. At least, for radioactive iodine and thyroid surgery. A lot of my patients do take the antithyroid medication to be safe, some take an herbal approach, but that’s a completely different topic.

Dr. Amy:

I just wanted to say that I think it’s so awesome, Dr. Eric, that you offer what you do. Because the person who just wrote in probably their endocrinologist has only offered surgery, or very few options. I just think it’s, really, it’s so great that you’re here and that you’re asking this question and looking into this. Because I think it’s really important that in our journey of healthcare and healing, that we have access to options and that you’re presented with like, “Well, you can go this route or you can go this route and here’s these different ways about this.” There’s a time and a place, but Dr. Eric has a lot of really great resources and an amazing approach to giving you another option that you don’t have to go for surgery necessarily. It’s one of the options.

Dr. Eric:

Thanks for that, Dr. Amy. My goal is to try to save people’s thyroid gland. It’s not always possible, but again, too many times the endocrinologist will say, “Someone needs to receive radioactive iodine or thyroid surgery.” Again, sometimes that is the best option, but many times that’s not the case. We have a thank you here, so you are welcome. Thanks for tuning in. Then Melissa here: “Sorry I missed the beginning, what kind of doctor do I need to see to get my adrenals tested? I’ve always had a fight or flight state of reacting situations and battled Graves on and off for the last six years. I know stress is a trigger, but never been tested or tried to cope with stress aside from yoga, meditation, lemon balm, motherwort, and CBD at night. What kind of doctor?” Obviously both Dr. Amy and I, we help people with adrenal problems. But I’ll let you expand on who would be a good option-

Dr. Amy:

Yeah, sure. You’re right to ask the question because not every doctor tends to offer testing for adrenals the way that we’re talking about really looking at that pattern over the day and looking at it more holistically. It’s going to be, I’m a naturopathic doctor, Dr. Eric’s a chiropractor, so an integrative functional medicine. More natural holistic practitioner is who’s going to be able to help you with that. I’ll mention, we do have an online group program that we run where we actually give you access and show you exactly how to order your own adrenal saliva test, and really get into the details of understanding what your results mean and what kinds of things to do to focus on to improve your adrenal function too.

That is something that we teach in our group program, which would be an easier to access lower cost way of getting help, or of course in the private practice of either one of us or a functional integrative naturopathic, holistic alternative, etc., practitioner would be able to help you with that too.

Dr. Eric:

All right. I will also add that probably the person who’s not going to treat your adrenals would be your primary care doctor or your endocrinologist, unfortunately. They might run a morning cortisol, maybe look at DHEA, but they’re usually not going to look at the circadian rhythm of cortisol through the saliva, through dried urine testing. Dr. Amy is right, and again, make sure you not only do the quiz, but her masterclass as well. Because that’s going to also… I don’t know if… It might not talk about testing and all that, but it is going to focus on adrenals, correct?

Dr. Amy:

Yes, it focuses on adrenals and strategies to help. It’s different kinds of strategies, it’s not just eat your protein and go to bed at night. There’s more to it than that. Yes, happy to share more with you.

Dr. Eric:

All right. Well, let’s try to get to a few more questions. We probably won’t be able to get to all of them, but Pili here, “is it recommendable to use the natural clock during perimenopause for those of us who no longer want to take the pill? Will the body temperature readings be too unreliable?” I’ll let you take this one.

Dr. Amy:

I can take that. I’m pretty sure what you’re referring to is for the sake of contraception. So during perimenopause, even though your cycles are irregular, you still can get pregnant. Being careful to prevent pregnancy if you’re not wanting to get pregnant is important to do. Taking temperature readings is one way of natural family planning of like noticing your temperature regulations and using that information to know when you’re ovulating and when you’re fertile, and then when you’re not. But, in perimenopause, you’re right to be concerned about that. It becomes more unreliable because the cycle length can change and it’s a lot harder to be sure of what your pattern is going to be and which days you’re more or less hurdle.

It’s already a less reliable method than some other forms of contraception. If you’re wanting to avoid pregnancy, I would be careful about relying on the temperature reading. But regulating your cycle, doing the things about stabilizing that foundation, whether that’s through adrenal support and then fibroid, blood sugar, getting your nutrition, your sleep patterns, all of that, can help to restore a more normal cycle. Which can be a more dependable pattern also. Hopefully, that helps.

Dr. Eric:

All right, do you have time for a couple of more questions?

Dr. Amy:

I could, yes. I love questions, I’m happy to help.

Dr. Eric:

Okay, because this I know someone asked in the Facebook group, “can perimenopause hormones trigger hyperthyroidism or hypothyroidism?” Do you want to cover it or do you want me to talk about it?

Dr. Amy:

No, you take that one.

Dr. Eric:

Okay, so I mentioned earlier, stress definitely could be a factor, and potentially, a trigger of Graves, Hashimoto’s, and I mentioned how chronic stress could affect the conversion of T4 to T3. So that could lead to low T3, which is the active form of thyroid hormone. As far as perimenopause or imbalances of the sex hormones being a trigger, the short answer I think would be no, in my opinion.  And so they’re not really a trigger. Women have been undergoing perimenopause for quite a long time, and I think we do see a relationship sometimes between hormone fluctuations and thyroid conditions…like postpartum thyroiditis is common. But even in that situation      I don’t look at the birth process as being a trigger, as most women have had the antibodies well before for Hashimoto’s. I haven’t seen it where it directly causes hyperthyroidism or hypothyroidism. But for those with Graves or Hashimoto’s, you might wonder is it a trigger? It might be a factor, but just about everybody will have had the autoantibodies for those conditions develop well before perimenopause. So to me I don’t consider it an actual trigger.

Dr. Amy:

Yeah, I agree. I’d say it’s a time in life where it often shows up and it gets discovered, but it’s not necessarily that the perimenopause is what triggered it. They probably never got screened beforehand or the stress of going through perimenopause is more so the trigger than the perimenopause itself, for example, or other things going on. I would say I see a lot of women, while their hormones are changing, it’s a time where you can have changes in your thyroid or discover those changes too. But with the case of the antibodies, it’s very likely that they’ve actually been around for longer and you just didn’t know it. It’s certainly not every woman who goes through perimenopause gets triggered into a thyroid problem, so it’s not a direct thing, but it can compound and come together.

Dr. Eric:

Yeah, it could be a contributing factor. Again, the stress I think is really big. What we spoke about earlier, not just the hormones, perimenopause, menopause, but let’s see, we got Shirley here, and she says “That would be me”, I guess, something you mentioned earlier. Then here we have Tracy:  “Dr. Amy and Dr. Eric, this is Tracy from New York. My saliva test results on Tuesday, 10:00 AM, 0.34, two…”

Dr. Amy:

This looks like cortisol, I think.

Dr. Eric:

Yeah, it’s the four different cortisol levels. Yeah, her first one she didn’t take until 10:00 AM, and then two third. Again, she might have not woken up until around that time, I’m not sure. I don’t know if this is saliva. Oh, yeah, actually she says saliva test results here. I was going to say the units are different from the testing that I’m used to seeing, and probably the same with you. But everything, other than that first one, obviously the first one is the highest, that’s the good news. It is the highest, the other ones are on the lower side. That third and fourth one are undetectable. I don’t know what the range would be for that first one, it depends on the lab. That also might very well, might be on the low side. But, yeah, definitely the other values are all on the lower side. I’m not sure what lab, but yeah, do you have any feedback?

Dr. Amy:

Pretty similar to what you’re saying, different labs have different reference ranges. I would just say look at your results in the normal range. A lot of labs report with a graphic too. You can see the zone on a graphic of what would normal be and then you look at your line compared to that. But like Dr. Eric was saying, the pattern is correct, your highest and then down and then down, so you’re not doing a reverse. But the later numbers for sure, and maybe even that first one are probably low. It’s more of that depleted, like needing to do a lot of restoration to help build back up again. But it’s good that you’re not getting that burst of second wind backwards thing at the end of the night.

Dr. Eric:

All right, thank you. Can you do two more? If you really have to go, I’ll let you go.

Dr. Amy:

No, no, I can do two more, I think.

Dr. Eric:

Okay.

Dr. Amy:

Yep, I’m up for five more minutes, so let’s go!

Dr. Eric:

Okay. Well, let’s do four minutes because I want to also give a minute to wrap up and also give your… so we’ll do like four.. We’ll definitely get you off by four minutes. “Can your adrenals cause pain in that area?”

Dr. Amy:

That’s an interesting question. Not commonly, but I have had some patients who are just really sensitive and really tuned into their bodies and feel like they have some sensation around that. But it’s not typical at all, usually, it’s not something that you’re feeling in your body right in that area. But it’s possible.

Dr. Eric:

Yeah, I would agree. It’s not something that’s common, but, yeah, it’s possible.

Dr. Amy:

Your body is talking to you in some way. But if you’re hurting in that area, I think it’s important to consider what else could be causing that pain. Is it your kidney or…

Dr. Eric:

Kidney, yeah, exactly.

Dr. Amy:

…muscle strain or just something going on with your back?

Dr. Eric:

All right. This might be the last one because it’s a long question. Let’s see. “I was recently diagnosed with Graves. I’ve been one month on Amy Myers protocol, no gluten, dairy, nightshades, eggs, daily curcumin, fish oil, zinc, vitamin Z, probiotic, along with 10 milligrams of methimazole, propranolol. My T3/T4 are back to normal.”

Dr. Eric:

“Liver function tests had gone up. I want to stop methimazole. Someone recommended herbal control my symptoms. Do you have any recommendations?” Okay, so you’re on 10 milligrams of methimazole and the liver function tests, so like AST, ALT have gone up. Maybe due to the methimazole and someone… Yeah. I could cover this. Again, can’t give specific recommendations, but when I was dealing with Graves, I did take bugleweed. I did not take the antithyroid medication. I mentioned earlier how a lot of my patients do take antithyroid medication, such as methimazole or sometimes PTU, or carbimazole if you live overseas. But, yeah, so I took bugleweed, and so that, again, I can’t tell someone to take bugleweed.

Dr. Eric:

My patients I could talk to them about it, but again, I’d say bugleweed and that did a pretty good job with me. The good news is 10 milligrams is still on the low side of methimazole, so you might be okay with making a transition. I will have some patients take methimazole and the bugleweed at the same time, usually, not exactly at the same time, but maybe like an hour or so apart. Again, I can’t tell them to stop taking methimazole as I mentioned. When I was in with Graves, I took five milliliters twice a day of 1:2 extract of bugleweed. But, again, that was my personal situation and I based it on the thyroid blood test. Then there’s motherwort.

Motherwort is more for the symptoms, not really affecting the thyroid, so like propranolol it’s similar to a beta blocker. I took bugleweed and I took motherwort, I actually started with bugleweed but still had some heart palpitations. Instead of taking a beta blocker, essentially, that’s the motherwort. But you want to be careful about abruptly stopping anything. I say let’s wrap it up just because it’s pretty close and I’ve already kept you longer than I promised. Just there’s so many questions and I hate leaving them unanswered. But anyway, register for the masterclass and let me put up one more time that replenishyourenergy.com/quiz​.

Again, I apologize for those that we didn’t get to your questions, but again, thanks for attending. If any questions specific for hyperthyroidism or Hashimoto’s, again, I do these on a regular basis. Not necessarily every single week, even though I think I will be on next week, so stay tuned. Then, again, Dr. Amy, by visiting her quiz, you’ll be on her list as well and you’ll get access to her masterclass. If you have more questions on adrenals, perimenopause, again, definitely fill out the quiz, attend the masterclass. But, again, Dr. Amy, I’d like to thank you again for, not only the answers you gave, but again, going over to make sure we get to some of the questions. Not all of them, but again, we got to a good number of them and appreciate you sharing your thoughts and feedback on adrenal health and perimenopause.

Dr. Amy:

Thank you so much for having me. It’s really fun and happy to answer questions and we’ll do more Q&A at the end of the masterclass too. Check the quiz and hope to stay in touch. Thank you, Dr. Eric, again, for the important work that you do and offering these options in between the nothing or the dramatic really important work. It’s so great that people have options when it comes to their Graves and their Hashi’s, and thank you for having me here today.

Dr. Eric:

All right, you’re welcome. It was a pleasure and maybe we’ll do it again in the future. Again, everyone have a wonderful day, a wonderful rest of your weekend. And same to you, Dr. Amy, have an awesome rest of your Friday and weekend as well.

Dr. Amy:

Thank you, bye.

Dr. Eric:

All right, bye everyone.

During the interview Dr. Day mentioned her “Why Am I SO Tired?” quiz, which you can check out by visiting the following link:

https://replenishyourenergy.com/quiz

She is also having a “From Fatigued to Fired Up” workshop in late March:

https://replenishyourenergy.com/fromfatiguedtofiredup

 

 

As you know, my practice focuses on helping people with thyroid and autoimmune thyroid conditions.  And while I’d have to say that the majority of patients I work with are solely “hypothyroid” or “hyperthyroid”, there are people who fluctuate back and forth between hyperthyroidism and hypothyroidism.  And so the purpose of this blog post is to discuss some of the reasons for this.

Let’s take a look at four different scenarios that can result in both hypothyroid and hyperthyroid symptoms:

Scenario #1: Having the antibodies for both Graves’ disease and Hashimoto’s thyroiditis.  It’s actually quite common for people to have antibodies for both Graves’ disease and Hashimoto’s.  The antibodies for Graves’ disease are thyroid stimulating immunoglobulins, which is a TSH-receptor antibody.  These cause an overproduction of thyroid hormone by binding to the TSH receptor.  On the other hand, thyroid peroxidase (TPO) and anti-thyroglobulin antibodies indicate that the immune system is causing damage to structures of the thyroid gland.  This can result in symptoms of hypothyroidism, although sometimes they can also result in transient hyperthyroid symptoms, which I’ll discuss next when explaining what Hashitoxicosis is.

So for example, Graves’ disease is characterized by a depressed TSH, elevated thyroid hormones, and elevated thyroid stimulating immunoglobulins.  Most people with this presentation will experience hyperthyroid symptoms.  However, if they also have TPO and/or anti-thyroglobulin antibodies there is the possibility that they might fluctuate back and forth between hyperthyroidism and hypothyroidism.  I can’t say that this fluctuation is common, as usually someone with Graves’ disease is predominantly hyperthyroid, while those with Hashimoto’s usually experience hypothyroid symptoms, although I’ll add that many people with Graves’ disease who also have Hashimoto’s antibodies will eventually become hypothyroid if the autoimmune component isn’t addressed. Keep in mind that it can take years for this to occur.

Scenario #2: Having Hashitoxicosis.  I’ve written a separate article on Hashitoxicosis, but I’ll summarize what it is it here.  Hashimoto’s thyroiditis is typically diagnosed when someone has an elevated TSH along with TPO antibodies and/or  thyroglobulin antibodies.  Many people with Hashimoto’s experience hypothyroid symptoms due to the thyroid hormone levels being either less than optimal or overtly low.  But why do some people experience hyperthyroidism? As I mentioned in the previous article I wrote, the hyperthyroidism experienced in Hashitoxicosis is caused by the release of preformed thyroid hormones caused by the destruction of thyroid follicles.

So these people might feel hypothyroid at times, but then at other times they essentially get a “flood” of thyroid hormone into the bloodstream, resulting in symptoms of hyperthyroidism.  Not only will they feel hyperthyroid, but if they get a blood test during these transient hyperthyroid periods it will reveal hyperthyroidism (low TSH, elevated T3 and T4).  Because of this it’s common for these people to be misdiagnosed with Graves’ disease, but this usually could be confirmed or ruled out by testing the thyroid stimulating immunoglobulins. In other words, if someone has a depressed TSH, elevated thyroid hormones (T3, T4), positive TPO and/or thyroglobulin antibodies, and NEGATIVE thyroid stimulating immunoglobulins, then there’s a good chance that the person has Hashitoxocosis and not Graves’ disease.

Scenario #3: Subacute thyroiditis. I can’t say that most people with subacute thyroiditis experience a fluctuation of hyperthyroid and hypothyroid symptoms, but it is possible.  I’ve also written a separate article on subacute thyroiditis, as this is usually caused by a virus, and the patient initially presents with hyperthyroidism, and over time will become hypothyroid.  So the person starts with hyperthyroidism and then usually becomes hypothyroid within a few months, but unlike Hashitoxicosis, it’s not common for people with subacute thyroiditis to feel hypothyroid one day and then hyperthyroid the next day.  I also should mention the research shows that coronavirus-19 can cause subacute thyroiditis, which I discussed in another article.

Scenario #4: Having Hashimoto’s and another condition that causes tachycardia. Tachycardia is an increased resting heart rate, and while this is a common symptom of hyperthyroidism, there can be other conditions that cause this.  Not too long ago I wrote a blog post entitled “Tachycardia and Thyroid Health“, and here are some of the factors that can cause an elevated heart rate.

• Hyperthyroidism
• Elevated cortisol levels
• Hypoglycemia
• Dehydration
• Hyperkalemia (high potassium levels)
• Hypomagnesemia (low magnesium)
• Hypocalcemia (low calcium)
• Infections
• Anemia
• Caffeine
• Certain medications
• Pregnancy
• Hypoxia
• Postural orthostatic tachycardia syndrome (POTS)
• Histamine intolerance

So for example, if someone has Hashimoto’s and elevated cortisol levels, an infection, or histamine intolerance, they might experience tachycardia at times.  Of course tachycardia isn’t the only symptom of hyperthyroidism, but it’s one of the most common symptoms, and so some people will assume they have hyperthyroidism if they have an elevated resting heart rate.  But if someone experiences tachycardia and every time they get a thyroid panel it looks fine or is more on the hypothyroid side, then the increased resting heart rate probably isn’t caused by hyperthyroidism.

It can sometimes be challenging to figure out what’s causing the increased resting heart rate.  On top of this, the person might have tachycardia and heart palpitations, both of which are common in hyperthyroidism.  But once again, just because someone has tachycardia and heart palpitations doesn’t mean they have hyperthyroidism.  I also wrote an article entitled “Heart Palpitations and Thyroid Health”, and if you read the article you’ll notice that some of the same factors that can cause tachycardia can also result in heart palpitations.

How Do You Treat These Conditions?

In the first two scenarios listed above you would want to focus on improving the health of your immune system.  Regardless of whether someone has the antibodies for Graves’ disease, Hashimoto’s, or both, you want to find and remove triggers, correct underlying imbalances, heal the gut, etc.  Of course this is easier said than done, which is why it’s a good idea to work with a competent healthcare practitioner.

As for the symptom management aspect, this is where it can be tricky.  If someone consistently is hyperthyroid then chances are they will take antithyroid medication or herbs (assuming they don’t receive radioactive iodine or thyroid surgery), whereas if someone is consistently hypothyroid they are likely to take thyroid hormone replacement.  But if they are fluctuating between hyperthyroidism and hypothyroidism then they wouldn’t want to take antithyroid agents or thyroid hormone replacement, and so focusing on the cardiovascular symptoms with a beta blocker or an herb such as motherwort or hawthorn would be an option to consider.

In the case of subacute thyroiditis (Scenario #3), while most people will initially be hyperthyroid for at least a couple of months, many medical doctors are still hesitant to give the person antithyroid medication.  Because of this, many people with subacute thyroiditis will be prescribed a beta blocker.  I don’t have a problem putting my patients with subacute thyroiditis on bugleweed while closely monitoring their symptoms and thyroid hormone levels.  But another option is to refrain from taking any antithyroid agents in this situation and just take something to manage the cardiovascular symptoms.

As for Scenario #4, you of course would want to address the autoimmune component of Hashimoto’s, while trying to figure out the cause of the elevated resting heart rate.  Since there are so many factors that can cause tachycardia it can sometimes seem like you’re searching for a needle in a very large haystack.

To summarize, if you were diagnosed with Graves’ disease and experience both hyper- and hypothyroid symptoms then you most likely fall into “Scenario #1”, although it’s also possible that you actually have Hashitoxicosis and not Graves’ disease.  On the other hand, if you have been diagnosed with Hashimoto’s and experience both hyper- and hypothyroid symptoms then you can fall under “Scenarios 1, 2, or 4”.

Do You Experience Hypothyroidism AND Hyperthyroidism?

If you fluctuate between hypothyroidism and hyperthyroidism I’d love to hear from you!  Do you have the antibodies for both Graves’ disease and Hashimoto’s? Or perhaps you were diagnosed with Hashitoxicosis? Either way I’m sure others who experience the same symptoms would love to hear what your experience has been.