Although I’ve been in remission from Graves’ disease since 2009, this doesn’t mean that I haven’t had some close calls regarding a relapse. One of these was in September of 2016, when I experienced my very first bout of shingles.  It was a very stressful year, as besides selling our house and moving into a new one, which was a very stressful process, that summer I broke my fifth metatarsal and was in a walking boot for a couple of months.  I’m sure the chronic stress that year was a big factor in weakening my immune system.

While I’m sure many reading this already know what shingles is, and some probably have experienced it themselves, for those unfamiliar with shingles I’ll briefly explain what it is.  Shingles is caused by the same virus that causes chickenpox…the varicella-zoster virus.  After someone gets chickenpox this virus stays dormant in the body in the nerve roots.  Years later the varicella-zoster virus can become active, thus causing shingles.

Shingles presents as a painful rash along the skin, and it usually affects one side of the body.  This was the case with me when I was dealing with shingles.  I also experienced persistent headaches a few days before the rash appeared, and since I rarely get headaches this was the first sign that something was wrong.  Most cases of shingles will last 2 to 4 weeks.

My case wasn’t too severe from both a pain-perspective and a duration perspective.  The concern I had was that the virus was around my auditory (hearing) nerves and did temporarily affect my hearing, and like many others with shingles, I was concerned that it would affect my eyes.  Yet another concern was that it might cause a relapse of my Graves’ disease condition, which fortunately didn’t happen, and I’ll elaborate on this later in this post.

Other Symptoms Associated With Shingles

I mentioned how in my case I had headaches, which not everyone with shingles experiences.  I then developed the rash.  Before getting the rash some people experience an increase in fatigue, and some will also have a slight fever.  There might be tingling sensations under the skin.  The rashes turn into small blisters and may or may not itch.  This stage can last up to five days.

After this stage the blisters dry up, and it can take two to ten days for this to happen.  As I mentioned earlier, shingles usually runs its course in two to four weeks, although some people do experience further complications.  I also should add that while shingles can develop anywhere on your body it most commonly affects the neck and chest.  And as I mentioned earlier, it can also affect the eyes and ears.

About The Varicella-Zoster Virus

Varicella-zoster virus is a member of the herpes virus family.  You no doubt are familiar with some of the other members of this family, which include herpes simplex virus type 1 and 2, along with Epstein-Barr and cytomegalovirus.  All of these viruses are very common, and just as is the case with varicella-zoster, these other viruses stay inactive in your body, but they can become active if your immune system becomes weakened.

What Triggers Shingles?

Just as a reminder, shingles is caused by reactivation of the varicella-zoster virus.  But since most people have this virus in their body (in a dormant state) why do some people get shingles and others don’t?  The main reason is due to a weakened or compromised immune system.  This is one reason why shingles is more common in the elderly, but my experience proves that it can affect anyone, as I was 45 years old when I had shingles.  And there’s no doubt in my mind that chronic stress was what weakened my immune system, as I mentioned in the opening paragraph.

Why Didn’t My Graves’ Disease Condition Return?

Infections are a potential trigger of autoimmune conditions such as Graves’ disease and Hashimoto’s, and this includes viruses.  But how can infections trigger autoimmunity, and why didn’t I suffer a relapse of my Graves’ disease condition when I was dealing with shingles?  Luck certainly played a role, but perhaps another reason relates to the Th1/Th2 balance of the body, which I discussed in a past blog post entitled “Should You Get Tested For Cytokines?”.  But just to briefly summarize here, most autoimmune conditions involve a shift toward the Th1 pathways, which is often referred to as “Th1 dominance”.  Th1 cytokines are involved in the eradication of intracellular pathogens.  In other words, the same type of immune response that kills infections can also drive autoimmunity.

However, many cases of Graves’ disease have been found to be “Th2 dominant” in the literature.  I personally didn’t have my cytokines tested when I was dealing with Graves’ disease, but assuming I was Th2 dominant, and if shingles causes a Th1 dominant state, then this may explain why I didn’t experience a relapse.  Of course this is just a theory, and there can be other factors that prevented a relapse from occurring.  As another example, according to the triad of autoimmunity, a leaky gut is a necessary component of an autoimmune condition.  As a result, if someone has a healthy gut and gets any type of infection that leads to a Th1 response, this shouldn’t lead to autoimmunity.

Balancing the immune system involves more than just Th1 and Th2, as in past articles and blog posts I’ve also discussed Th17 cells and regulatory T (Treg) cells, which also need to be in balance to prevent autoimmunity from developing.  While Tregs play an important role in preventing autoimmunity and can also benefit people with viral infections by suppressing tissue damage caused by virus-specific T cells (1), lowering the T cell numbers can also make it more challenging to eradicate the infection.  Similarly, Th17 cells also play a role in eradicating infections, but too many Th17 cells can lead to autoimmunity.

This is what can make shingles and other viruses challenging to treat in someone who has Hashimoto’s thyroiditis, which is typically a Th1 dominant condition.  Normally with Hashimoto’s you want to do things to increase Tregs in order to dampen both the Th1 and Th17 response, but this can also make it challenging to eradicate infections.   If this is confusing to you then join the club, as many practitioners also find this to be complex, and there’s still a lot we don’t know about managing infections in autoimmunity.  With regards to viruses, probably the best approach is to take something to inhibit or decrease the replication of the virus, and then incorporate dietary and lifestyle changes to improve the health of the immune system.

Does The Research Show Any Relationship Between Shingles and Thyroid Autoimmunity?

Although there is research showing that Epstein-Barr and other viruses can be triggers of autoimmune thyroid conditions, I wasn’t able to find any evidence specifically showing that shingles can trigger Graves’ disease or Hashimoto’s. However, there is evidence that other autoimmune conditions are associated with varicella-zoster, including lupus, rheumatoid arthritis, and inflammatory bowel disease. But this doesn’t mean that shingles can’t be a potential trigger, although as I suggested above, since viruses cause a shift towards a Th1 dominant state it probably is more likely to trigger Hashimoto’s thyroiditis. However, it’s important to mention that like Hashimoto’s, Graves’ disease also involves an imbalance between Th17 and Treg cells, which is associated with the reactivation of varicella-zoster. So in all likelihood shingles can cause the development of Hashimoto’s autoantibodies in some cases, and perhaps even Graves’ disease autoantibodies.

Can You Get Shingles More Than Once?

I’m not a big fan of seeing medical doctors, and initially I wasn’t going to see one when I developed shingles, but my wife strongly urged me to go, and so I reluctantly went.  The doctor I spoke with also had experience with shingles, as he told me that he had it three times!  I mention this because some sources will say that those who get shingles will usually only get it once in their lifetime.  But since the virus remains dormant in your body it is possible to have multiple reactivations.  This is yet another reason to constantly work on improving your immune system health.

What Is Post-Herpetic Neuralgia?

Although most people who get shingles fully recover, which fortunately includes myself, a small percentage (10 to 20%) experience something called “post-herpetic neuralgia”.  This is characterized by severe pain from the nerve damage caused by the virus.  This pain can last from a few weeks to a few years in some cases, and the risk of getting this is almost 30% higher in people older than age 50 (2).  Later in this post I’ll discuss some natural treatment alternatives that can treat and prevent post-herpetic neuralgia.

Conventional Treatment Options For Shingles

Not surprisingly, conventional treatment options don’t do anything to improve the health of the person’s immune system, but instead are aimed at stopping the virus from replicating.  Most medical doctors will treat shingles with antiviral medication.  It is advised to start antiviral therapy no later than 72 hours after the rash starts, and this potentially can help to speed up recovery time and also help with the pain.  It can also reduce the chance of developing post-herpetic neuralgia.

There are times when antiviral medication is warranted, but of course everything comes down to risks vs. benefits.  Although losing your vision or hearing is rare due to shingles, it’s a possibility, and so if the virus has affected the auditory or visual nerves then this might be a situation when it’s wise to take the medication.  If someone is dealing with severe pain then this might be another reason to consider the antiviral meds, not only to help with the pain, but it can reduce the chances of developing post-herpetic neuralgia.

The antiviral meds most commonly given include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir Novartis). Just as is the case with other medications, side effects are possible with these antiviral drugs.  For example, some of the common side effects of acyclovir include nausea, vomiting, diarrhea, loss of appetite, stomach pain, headaches, lightheadedness, and swelling in your hands and feet (3).  In rare cases this drug can cause kidney problems (3).

It’s also important to mention that if someone is experiencing a lot of pain, some doctors will recommend corticosteriods (i.e. Prednisone) to help.  This very controversial, even in the literature, and the reason for this is because while these drugs might help to lessen the severity of the pain, corticosteroids suppress the immune system, which isn’t a good thing when dealing with an active viral infection.  So in most cases it’s probably a good idea to steer clear from corticosteroids, as there are other things you can take if the pain is severe.

Combining Conventional vs. Natural Treatment Options

Below I’ll talk about natural treatment options for shingles, but I should add that you don’t necessarily have to choose between conventional and natural treatment options.  If you decide to stick solely with a natural treatment approach that’s fine, but if you choose to take antiviral meds you still want to do things to improve the health of your immune system.  This is important not only to prevent shingles from coming back in the future, but of course keeping your immune system healthy will reduce the likelihood of other viruses in your body from reactivating, along with preventing new infections from developing.

Should You Consider Getting The Shingles Vaccine?

Yet another controversial topic is whether people should get the shingles vaccine.  As of writing this blog post there are two vaccines for shingles.  Zostavax has been in use since 2006, and involves the use of an attenuated (weakened) live virus).  According to the CDC this vaccine reduces the risk of developing shingles by 51% and post-herpetic neuralgia by 67%, and protection last for about five years (4).  It is recommended for people 60 through 69 years of age.

A new shingles vaccine called Shingrix was licensed by the FDA in 2017, and this involves a dead virus.  This is the preferred vaccine according to the CDC, as according to them this vaccine is more than 90% effective at preventing shingles and post-herpetic neuralgia (5).  They also claim that protection stays above 85% for at least the first four years after being vaccinated (5).

Of course everything comes down to risks vs. benefits, and while I’m not a big fan of vaccines, this ultimately is a decision you need to make.  The truth is that the shingles vaccine very well might help to reduce the likelihood of getting shingles, and the overt side effects of the vaccine seem to be minimal.  But you shouldn’t overlook the “inactive” ingredients included in these and other vaccines, as this is where a lot of the controversy lies.  There is also some controversy as to whether vaccines should be administered in those with autoimmune conditions, and while the CDC doesn’t list autoimmunity as a contraindication, many health experts would disagree with this.

As you probably know, your immune system doesn’t instantly become unhealthy once you reach age 50, which is when the CDC recommends people to get the new shingles vaccine.  That being said, many people aged 50 or older have an unhealthy immune system because they don’t eat well, don’t get sufficient sleep, do a poor job of managing their stress, etc.  In this case the shingles vaccine may help, but of course it won’t do anything to improve your immune system health.  In fact, even if you decide to get the shingles vaccine you should do things to improve your immune system health, which I’ll discuss towards the end of this blog post.

Natural Treatment Options For Shingles

Just as is the case with all other viruses, you can’t eradicate the varicella-zoster virus from your body.  When it’s active the goal is to do things to slow down the replication in order to put it in an inactive state, while improving the health of the immune system to prevent it from reactivating in the future.   So what I’m going to do is divide the following into two parts, as I’ll first discuss some herbs and nutrients that can help inhibit viral replication, and then I’ll discuss a few things you can do to improve your immune system health.

Herbs and Nutrients To Prevent Viral Replication

Although I’m listing multiple herbs and nutrients below, this doesn’t mean that those with shingles should take all of them.  What I’ll do is first list herbs and nutrients that have been shown to help with the varicella-zoster virus in the literature, and then I’ll list other natural agents with antiviral properties.  It’s important to understand that the lack of studies for certain agents doesn’t mean that it can’t have antiviral activity against varicella-zoster.  For example, quercetin is listed below, and while I couldn’t find any studies which showed that it has antiviral activity specifically against varicella-zoster, I also didn’t come across any studies which demonstrated that it lacked antiviral activity against this virus.  Perhaps future studies will be conducted to determine whether quercetin and other natural agents can be beneficial for preventing replication of the varicella-zoster virus.

Licorice root.  I really do like the herb licorice, and while I commonly recommend licorice root to my patients who have depressed cortisol levels, this herb also has antiviral activity. One study showed that licorice has low antiviral activity against varicella-zoster compared with acyclovir (6).  Licorice root can potentially increase blood pressure, and so if someone has a history of hypertension taking this herb wouldn’t be a good idea.

Resveratrol.  I don’t usually recommend resveratrol for anti-viral purposes, but I came across one in vitro study that showed that resveratrol can inhibit the replication of the varicella-zoster virus (7).

Vitamin D.  I’ve spoken about the importance of vitamin D numerous times in past articles and blog posts, and a few studies show that it might affect the course of shingles and post-herpetic neuralgia (8) (9).

Vitamin C.  A few studies have shown that administering vitamin C intravenously can help with the pain of shingles and post-herpetic neuralgia (10) (11).  One of these was a case report where the patient didn’t respond to conventional treatment, but IV vitamin C resulted in an immediate reduction in the pain.

Quercetin.  Although quercetin is known for its anti-histamine properties, it also has antiviral activity.  Unfortunately I wasn’t able to find any studies showing that it can inactivate the varicella-zoster virus, but there is evidence of it helping with other types of viruses (12) (13).

St. John’s Wort.  Although this herb is commonly known for its anti-depressive properties, it also has antiviral properties (14), but I also wasn’t able to find evidence of it helping with varicella-zoster.  There are a lot of herb-drug interactions involving St. John’s Wort, and so I’d be cautious about taking it on your own.

Lysine.  Although there is evidence that lysine can inhibit the replication of herpes simplex virus (15) (16), I couldn’t find evidence of it helping with varicella-zoster.  Once again, this doesn’t mean that it can’t be of benefit, but I’m not sure if taking lysine will prevent the onset of shingles.

Other natural agents.  Other natural agents that have antiviral properties, although not necessarily against varicella-zoster, include garlic, turmeric, monolaurin, and certain essential oils.

Can Ozone Therapy and UV Light Help With Shingles?

I can’t say I have much experience with ozone therapy, and while there is some evidence that ozone can help with the inactivation of viruses (17), I couldn’t find anything specific related to shingles, although you might want to check out this video.  I did come across a study that showed that broad band ultraviolet light B (UVB) might play a role in the prevention and treatment of post-herpetic neuralgia (18).

How To Improve Your Immune System Health

There are many different things you can do to improve your immune system health.  While I just listed a few nutrients and herbs that can help to inhibit viral replication, I don’t recommend loading up on supplements to improve your immune system health.  This doesn’t mean that supplements can’t play a role, but you want to make sure you cover the basics:

1. Improve your stress handling skills.  Although eating a healthy diet probably should be on top of this list, I started with stress because this is a big reason why many people develop shingles.  This was true in my case, and I’m pretty sure it was the case with the medical doctor I saw who had shingles three separate times.  Sure, chronic stress isn’t the only reason for the reactivation of viruses, but it’s a big reason.  As a result, you want to make sure you block out time for stress management on a regular basis.

2. Get sufficient sleep.  If you don’t get sufficient sleep then this will compromise both your adrenals and immune system.  Once again, supplements can help in some cases, but even when this is the case you only want to take supplements on a temporary basis.  In the past I wrote an article where I discussed how to get optimal sleep without taking supplements, and if you haven’t read this I definitely would do so when you get the chance.

3. Eat well.  Eating healthy whole foods is important for optimal immune system health.  I probably don’t have to talk much about this here, and I have written plenty of articles and blog posts on my website related to this topic.  However, I should say that while I commonly recommend restrictive diets such as the autoimmune Paleo (AIP) diet, it’s common for people to get stressed out about this diet when trying to restore their health.  Just keep in mind that an AIP diet isn’t meant to be a long-term diet, and of course the most important factor is to try to eat mostly whole foods while avoiding fast food, refined foods and sugars, etc.

4. Improve your gut health.  Since 70 to 80% of the immune system cells are located in the gastrointestinal tract, it makes sense that you would need a healthy gut to have a healthy immune system. Of course eating well is the big key to having a healthy gut, although infections, Candida overgrowth, and certain chemicals (i.e. glyphosate) can cause intestinal dysbiosis, and so these need to be addressed.  To achieve optimal gut health I recommend following the 5-R protocol.

In summary, many people will develop shingles, which can be a very painful condition.  Varicella-zoster is the virus associated with shingles, and the main risk factor for developing shingles is a weakened immune system, with stress being a big factor.  Some people with shingles develop post-herpetic neuralgia, which is characterized by severe pain from the nerve damage caused by the virus. Conventional treatment options for shingles usually involve taking antiviral medication, and the new shingles vaccine is commonly recommended for people aged 50 and older.  Natural treatment options can also help, and even if you choose to take antiviral drugs you can combine this with natural treatment methods, and you still want to do things to improve the health of your immune system.

I hope you enjoyed this blog post, and if you have had shingles in the past please feel free to share your experience in the comments section below.

Although I’ve written numerous articles and blog posts on thyroid antibodies, I’ve decided to dedicate a blog post to thyroid peroxidase (TPO) antibodies.  There are a few different types of thyroid antibodies, but I’d like to focus on TPO antibodies because they are the most common type of thyroid antibody.  Although they are more commonly associated with Hashimoto’s thyroiditis, TPO antibodies are frequently elevated in Graves’ disease as well.

So what are TPO antibodies, and what differentiates them from other types of autoantibodies?  First of all, TPO antibodies develop when the immune system attacks thyroid peroxidase.  What is thyroid peroxidase?  Thyroid peroxidase is an enzyme that plays a major role in the synthesis of thyroid hormone.  This enzyme converts iodide to iodine, and the iodine combines with tyrosine on thyroglobulin, which forms thyroxine (T4) and triiodothyronine (T3).  So when someone has elevated TPO antibodies, this indicates that the immune system is attacking the thyroid peroxidase enzyme, which in turn can inhibit the production of thyroid hormone, thus eventually leading to hypothyroidism.

It’s worth mentioning that there also is a thyroid peroxidase (TPO) gene.  Some people will have genetic polymorphisms (mutations) of the TPO gene, which can lead to severe defects in thyroid hormone production due to total iodide organification defects or partial iodide organification defects (1).  One study identified six different genetic defects of the TPO gene, and found that three of these are significantly associated with hypothyroidism (1).

Are people with Hashimoto’s and Graves’ disease who have anti-TPO antibodies more likely to have genetic polymorphisms of the TPO gene?  The studies are conflicting, as some show no association, while other studies did demonstrate an association between TPO genetic defects and anti-TPO antibodies (2).  With genetic testing more popular these days you might wonder if you can get tested to see if you have any TPO polymorphisms.  As of writing this article I’m unaware of any labs available to the public which conducts this type of testing, although I’m sure it’s only a matter of time before it becomes readily available.

TPO Antibodies In Other Autoimmune Conditions

According to the research, anti-TPO antibodies are detected in 90 to 95% of those with autoimmune thyroid conditions, including 80% in those who have Graves’ disease (3).  It’s common for those with other autoimmune conditions to have elevated anti-TPO antibodies, as one study showed that anti-TPO antibodies were present in 37% of those with rheumatoid arthritis (4).  Another study showed that approximately 39.6% of people with type 1 diabetes had anti-TPO antibodies (5).  In celiac patients, anti-TPO antibodies have been detected in 11.7 to 30.5% of patients (6), although other studies have shown a higher percentage (7).

What Causes Elevated TPO Antibodies?

In other blog posts and articles I’ve discussed the triad of autoimmunity.  This is also known as the 3-legged stool of autoimmunity, and it includes 1) a genetic predisposition, 2) exposure to an environmental trigger, and 3) an increase in intestinal permeability (a leaky gut).  So the reason why one person might develop elevated anti-TPO antibodies, while another person will develop thyroid stimulating immunoglobulins, is because they have different genetics that predispose them to different autoimmune conditions, and thus different autoantibodies.  Some people have both anti-TPO antibodies and thyroid stimulating immunoglobulins, which means they have the genetic markers for these two autoantibodies.

But just because someone has a genetic predisposition for developing anti-TPO antibodies doesn’t mean they will develop them.  Once again, according to the triad of autoimmunity, they also need to be exposed to a trigger and at the same time have a leaky gut.  I have discussed some of the different triggers of thyroid autoimmunity in different articles and blog posts, as well as in my books on Graves’ disease and Hashimoto’s.  I’ve also written numerous articles and blog posts on leaky gut syndrome, with my latest one entitled “5 Things To Know About Leaky Gut Syndrome”.

What Is The Reference Range?

Just as is the case with other markers, different labs will have different reference ranges.  For example, the TPO antibodies reference range for Quest Diagnostics is <9 IU/mL.  On the other hand, the reference range for Labcorp is 0−34 IU/mL.  You might wonder what the “optimal” reference range is, and while this is debatable, there is no question that you want to see this value as low as possible, and so I prefer to see it <9 IU/mL.

It’s also important to mention that higher TPO antibodies don’t necessarily correlate with how much damage is taking place to the thyroid gland.  Don’t get me wrong, as just like most natural healthcare practitioners, I like to see these and other autoantibodies decrease, and eventually normalize.  But if someone’s TPO antibodies is 1,000 IU/mL, this doesn’t mean that it’s ten times more severe than someone whose TPO antibodies are 100 IU/mL.

The Relationship Between Thyroid Peroxidase and Iron

Thyroid peroxidase is a heme-containing enzyme (8), which means that it requires iron to function properly.  As a result, it shouldn’t be surprising that a few studies show that iron deficiency anemia can impair thyroid metabolism by reducing TPO activity (8) (9).  Another study showed that iron deficiency anemia not only can lead to hypothyroidism, but elevated TPO antibodies (10).

Iron deficiency anemia is so important that a few years ago I dedicated an article on this topic.  One of the big problems is that many medical doctors will only test for serum iron or ferritin, instead of ordering a full iron panel.  Another problem is that most will rely on the lab reference ranges.  So for example, someone might present with a ferritin of 18 ng/mL, which is considered to be normal by most labs, yet is well below optimal.  Also keep in mind that inflammation can increase ferritin, and so if someone has normal or high ferritin levels, this alone won’t rule out an iron deficiency.

How Can You Decrease TPO Antibodies?

If you have elevated anti-TPO antibodies, or any other type of autoantibody, you will need to do the following to decrease and normalize these:

1. Remove the autoimmune trigger.  It makes sense that the autoimmune trigger needs to be removed in order to decrease autoantibodies and to help the person get into a state of remission.  It can be challenging to find someone’s triggers.  In fact, that’s why I wrote and released the book Hashimoto’s Triggers earlier this year!  My goal isn’t to plug my book here, but I really do believe it’s the most comprehensive book on finding and detecting autoimmune triggers.  And while the book was written for Hashimoto’s patients, a lot of the information can also benefit people with other autoimmune conditions, including Graves’ disease.

2. Heal the gut.  Since a leaky gut is part of the triad of autoimmunity, it shouldn’t be surprising that healing the gut is also necessary to decrease TPO antibodies.  While it’s common for people to take gut healing nutrients such as L-glutamine, and consume gut healing foods such as bone broth, for optimal gut health you need to reduce the factor that is causing the leaky gut in the first place.  For example, if you have a gut infection that is causing a leaky gut, you can supplement with L-glutamine and drink bone broth every day and you won’t heal your gut until the infection has been eradicated.

3. Reduce proinflammatory cytokines and increase glutathione levels.  Proinflammatory cytokines are a factor in autoimmunity, and while removing the trigger and healing the gut can help to reduce inflammation, you might have to do other things to reduce proinflammatory cytokines.  Speaking of proinflammatory cytokines, an interleukin called IL-17 plays a key role in autoimmunity, and when IL-17 binds to its receptor it causes the production of other proinflammatory cytokines, including IL-1, IL-6, and TNF-alpha.  Some of the factors which can decrease proinflammatory cytokines include vitamin D, fish oils, and curcumin.

Vitamin A also can play an important role in reducing IL-17.  It does so by turning on something called FOXP3, which will lead to a greater production of regulatory T cells (Tregs) and less Th17 cells.  Th17 cells are one of the IL-17 producing cells.  On the other hand, Tregs play a role in suppressing autoimmunity.  So essentially you want a lot of Tregs and a low number of Th17 cells.

As for glutathione, this is a potent antioxidant that can help to reduce oxidative stress associated with autoimmunity.  Glutathione peroxidase can help to reduce free radicals (11), which can also decrease proinflammatory cytokines.  Many people with autoimmune conditions such Graves’ disease and Hashimoto’s have a glutathione deficiency.  This is important to bring up, as if someone has a glutathione deficiency but does other things to reduce proinflammatory cytokines (i.e. take fish oils), then this alone won’t be sufficient to decrease TPO antibodies. This is one reason why a few studies show that taking selenium can decrease thyroid antibodies (12) (13).  Selenium is a cofactor of glutathione peroxidase, and thus a selenium deficiency can cause a glutathione deficiency.

While it’s important to increase glutathione levels, which can be accomplished through diet and/or supplementation, you also want to address the cause of what’s depleting the glutathione.  In a recent article I wrote entitled “Glutathione and Thyroid Autoimmunity” I discussed some of the factors that can deplete glutathione, which includes environmental toxins, acetaminophen and other medications, alcohol consumption, and nutrient deficiencies.

4. Correct other imbalances.  While arguably the first three things mentioned here are the most important factors when trying to decrease TPO antibodies, you also want to correct other imbalances that may be present.  As an example, cortisol plays an important role in controlling inflammation.  As a result, if someone has compromised adrenals that presents as depressed cortisol levels, then it will be challenging to decrease proinflammatory cytokines.

I’ve written a few blog posts where I discussed the relationship between oral health and thyroid health.  A few studies have shown that periodontal disease can cause an increase in Th17 cells (14) (15), which are associated with Hashimoto’s and other autoimmune conditions.  And while more research has focused on the correlation between rheumatoid arthritis and periodontal disease (16) (17), there is also evidence that Hashimoto’s thyroiditis can be associated with periodontal disease (18).  More research is needed in this area as well, but if you have inflamed gums it’s possible this needs to be addressed in order to restore your health.

Are TPO Antibodies Protective Against Breast Cancer?

I found it interesting that some studies show that there is a protective effect of anti-TPO antibodies for women with breast cancer (19).  The studies show that women with breast cancer who also had elevated TPO antibodies had better survival rates (20).  The authors of one study hypothesized that breast TPO may participate in the regulation of oxidative stress in breast tissue (21).

In summary, thyroid peroxidase (TPO) antibodies are the most common type of thyroid antibody.  Although they are more strongly associated with Hashimoto’s, 80% of those with Graves’ disease will have elevated TPO antibodies.  As for what causes elevated TPO antibodies, according to the triad of autoimmunity someone needs to have a genetic predisposition, exposure to an environmental trigger, and a leaky gut in order to develop autoimmunity, and thus elevated autoantibodies. As a result, in order to decrease TPO antibodies you need to find and remove the autoimmune trigger, heal the gut, and you might also need to do other things to reduce proinflammatory cytokines and increase glutathione levels.  As discussed in this blog post, correcting other imbalances might also be necessary to lower TPO antibodies.

For many years stevia has been considered to be a safe sugar substitute, but recently there has been some controversy over this natural sweetener.  In fact, some healthcare professionals now recommend for their patients to avoid stevia.  Some of my thyroid and autoimmune thyroid patients have also questioned whether or not it’s safe to consume stevia, and so I figured I’d dive into the research and put together a blog post on this topic.

Before discussing the health benefits and potential risks of stevia I’d like to cover a few basics.  First of all, stevia is a plant that has been used as a sweetener for hundreds of years.  However, it’s only been recent that many products have included it as a sugar substitute.  Some of the products that include stevia include soft drinks, ice cream and other desserts, protein powders, and many other products.

Whole plant stevia is also known as Stevia rebaudiana Bertoni.  Stevia extract refers to a preparation that is made by steeping the leaves of the stevia plant, which in turn extracts the compounds responsible for the plant’s sweet taste.  These compounds are called steviol glycosides.  There are 11 major steviol glycosides, and rebaudioside A and stevioside are the most abundant (1).  High-purity stevia extracts consisting of 95% or greater steviol glycosides are required to meet US and European regulatory approvals and safety standards for foods and beverage use.

Health Benefits of Stevia

The truth is that many people don’t use stevia for any specific health benefits.  For example, many people add stevia to coffee or tea as a substitute for white sugar and/or artificial sweeteners.  But there is research demonstrating specific health benefits of stevia, which I’ll discuss below:

Diabetes Mellitus.  One rat study looked at the effects of stevia leaves and its extracted polyphenols on diabetes (2).  The results of the study showed a reduction of blood glucose, the liver enzymes (ALT and AST) and insulin, and suggested that stevia leaves not only have a hypoglycemic effect, but can also alleviate liver and kidney damage.  Another study showed that aqueous extract of stevia has anti-diabetic effects in albino rats (3).

Hypertension.  A few animal studies show evidence that stevia may help to reduce blood pressure.  One study showed that stevioside given intravenously to hypertensive rats was effective in blood pressure reduction (4), while another study on hypertensive dogs showed that stevioside is an effective antihypertensive natural product (5).  A human study investigated the long-term efficacy and tolerability of stevioside in patients with mild essential hypertension (6).  The study showed that after 2 years, the stevioside group had significant decreases in systolic and diastolic blood pressure.

Cancer.  Although a few in vitro studies demonstrated that Stevia rebaudiana extracts have antiproliferative and proapoptotic properties on cancer cells (7) (8), including pancreatic cancer cell lines (9) (10), another study showed no impact of stevia on the pancreatic cancer (11).

Inflammation.  A few studies show that stevioside possesses anti-inflammatory and immunomodulatory properties by decreasing the synthesis of proinflammatory cytokines (12) (13).  And since an increase in proinflammatory cytokines is associated with autoimmune conditions, perhaps stevia can benefit people with Graves’ disease and Hashimoto’s.

Obesity.  There is evidence that by lowering energy intake, stevia may lead to the reduction and prevention of obesity (14).

Lyme disease.  One study looked at the effectiveness of whole leaf Stevia extract against Borrelia burgdorferi species, which are associated with Lyme disease (15).  The results of the study demonstrated that Stevia had significant effect in eliminating Borrelia burgdorferi spirochetes and persisters, and therefore might be an effective agent in helping people with Lyme disease.

Tooth decay.  Stevia is non-cariogenic, and when used over table sugar it can be a way of preventing dental caries (16).  In addition, some of the stevia extracts exhibits antimicrobial properties against the bacteria that play a role in tooth decay (17).

What Are The Risks of Stevia Consumption?

Over the last few years there has been some controversy related to stevia.  Here are a few of the controversies associated with stevia:

1. Stevia and fertility.  There is an animal study that showed that chronic administration of a stevia extract may decrease the fertility of male rats (18).  There are a few problems with this study.  First of all, it was a single study that hasn’t been reproduced.  Second, it was conducted on rats, and animal studies don’t always translate to humans.  And third, the abstract didn’t specify how much stevia was given to the rats over the 60 day period.  The truth is that more research is needed, but if someone is having fertility problems and consumes stevia regularly then it probably is best to stop consuming it, just to play it safe.

2. Stevia and gut bacteria.  One study evaluated the influence of stevia glycosides on the growth of Lactobacillus reuteri strains (19).  According to the study, two stevia glycosides impaired the growth of the analyzed strains.  This doesn’t mean that consuming stevia will affect all of the strains of Lactbacillus retueri, let alone other strains of bacteria.  Once again, more research is needed, and even the study concluded that it’s necessariy to evaluate the influence of stevia glycosides on other groups of micro-organisms.

3. Stevia and Cytochrome P450 enzymes.  I came across a study which showed that steviol caused a weak inhibition of CYP3A4 and CYP2C9 (20).  These enzymes play a role in the metabolism of certain drugs.  As a result, food-drug interactions can be a concern when taking stevia.

4. Stevia and ragweed allergies.  Although I haven’t come across any research that has showed an association between stevia and ragweed allergies, I’ve read some blog post comments suggesting that people were unable to tolerate stevia for this reason.  Stevia is part of the Asteraceae/Compositae plant family, which includes ragweed, chrysanthemums, marigolds, daisies, and other plants (21).  In theory, people who have allergies to ragweed and other plants in the same family may also react to stevia.

Other Natural Sugars and Sweeteners To Consider

For those who choose not to consume stevia, you might wonder which other natural sweeteners are safe to consume.  I’ll refer you to a blog post I wrote in the past entitled “Natural Sugars, Sweeteners, and Thyroid Health”, as I discuss the different natural sweeteners.  I even discussed stevia, although this current blog post goes into much greater detail.  Even though I recommend reading the blog post I wrote on natural sweeteners, here are four natural sugars and sweeteners to consider using:

• Honey
• Maple syrup
• Molasses
• Luo han (monk fruit)

Beware of “Hybrid” Stevia Products

If you choose to consume stevia, ideally it should be 100% whole leaf stevia without added ingredients.  Some products will include stevia, but will also include other sweeteners such as sugar alcohols or agave, both of which I discuss in the blog post I’ve written in the past on natural sugars and sweeteners.  Dextrose is another ingredient added to some stevia products, and this is commonly derived from genetically engineered corn.  Not only do you need to be aware of other ingredients included, but some of these are highly processed using numerous chemicals to extract the steviol glycosides from the leaf.

Should You Avoid Stevia?

I personally have reduced my consumption of stevia recently, although I don’t completely avoid it.  I used to add stevia regularly to my green tea and herbal teas, but over the years I have learned to enjoy these without stevia…or any other sweeteners.  So I don’t add honey to my tea, or any other sweeteners.  I do I use an electrolyte powder that has stevia (after my sauna therapy sessions).

The truth is that more research is needed, but probably the same is true for many other herbs.  After all, while herbs such as ashwagandha, rhodiola, milk thistle, etc., are overall considered to be safe, there are some people who don’t tolerate these and other herbs.  As for whether stevia can affect fertility, more research is definitely needed, but my guess is that there have been many people who were able to conceive while consuming stevia.  That being said, if someone is having a difficult time conceiving then it might be wise to take a break from stevia.

My biggest concern with stevia is the evidence showing that a few stevia glycosides inhibited Lactobacillus reuteri strains.  And I mentioned earlier that one of the benefits of stevia is in preventing tooth decay by inhibiting certain bacteria, which includes Streptococcus mutans and Lactobacillus acidophilus.  Keep in mind that this doesn’t confirm that consuming small amounts of stevia will cause gut dysbiosis, and we need to keep in mind that there are other herbs that also possess antimicrobial properties, including oregano and berberine.

Overall I think 100% whole leaf stevia is a safe option for many people when taken in small amounts.  This doesn’t mean that everyone will tolerate it well, but the same is true when taking herbs, as many people do fine when taking certain herbs, while some people have a negative reaction.  And so you need to listen to your body.  As I mentioned earlier, if someone is trying to conceive it might be best to take a break from stevia, although if anyone reading this has conceived while consuming stevia regularly please feel free to share this in the comments section below.

In summary, many people use stevia as a natural sweetener.  Stevia can potentially benefit those with diabetes mellitus, high blood pressure, cancer, inflammation, obesity, Lyme disease, and even tooth decay.  There is some evidence that stevia can decrease fertility and have a negative effect on some of the good bacteria.  However, more research is needed in these areas.  My opinion is that stevia is similar to other herbs in that it offers some good benefits when taken in small amounts, but there are also potential risks.  And just as is the case with other herbs, some people may have an allergy to stevia.  If you choose to consume stevia it’s best to use 100% whole leaf stevia.

Please feel free to share your thoughts about stevia in the comments section below!

Although it’s a wonderful feeling to help someone with hyperthyroidism avoid radioactive iodine and thyroid surgery, there are certain precautions you need to take when trying to restore your health.  This is true whether you have Graves’ disease, or a different hyperthyroid condition (i.e. toxic multinodular goiter).  In this blog post I’m going to specifically focus on five precautions you should take when trying to reverse your hyperthyroid condition through a natural treatment approach.

Precaution #1: Safely manage your symptoms.  Although not everyone with hyperthyroidism experiences an elevated resting heart rate, many people do.  Some people have a resting heart rate between 80 and 100 beats per minute, while others have a resting heart rate well over 100 BPM.  I’ve worked with some patients whose resting heart rate was around 150 BPM when they weren’t taking anything.

Without question there is a risk of uncontrolled hyperthyroidism.  When I was dealing with Graves’ disease back in 2008/2009 I was able to effectively manage my symptoms by taking bugleweed and motherwort.  Some people choose to manage their symptoms by taking antithyroid medication and/or beta blockers.  Others prefer to manage their symptoms naturally like I did.  Others attempt to manage their symptoms with bugleweed, motherwort, and/or other herbs but are unable to do so, and need to resort to taking the medication.

In any case, while there might not be as big of a concern if your resting heart rate is slightly elevated, if it is moderately or severely elevated (i.e. greater than 90 BPM) then you want to do something to manage the symptoms.  This might involve taking antithyroid medication (i.e. Methimazole) and/or beta blockers, or in some cases nutritional supplements and herbs such as bugleweed, motherwort, lemon balm, and/or L-carnitine.

Precaution #2: Monitor your liver enzymes.  Many people with hyperthyroidism have elevated liver enzymes.  This is especially true for those who take antithyroid medication such as Methimazole or Propylthiouracyl (PTU).  However, some people with hyperthyroidism have elevated liver enzymes even when not taking antithyroid medication.

Ordering a liver function panel is a good idea for anyone with hyperthyroidism.  This can be ordered separately, although it’s also part of a comprehensive metabolic panel.  The two main liver markers it tests for are alanine aminotransferase (ALT) and aspartate aminotransferase (AST).  Alkaline phosphatase is also commonly elevated, although an elevation of this enzyme doesn’t always indicate a problem with the liver.

I wrote a separate article that focused on these liver markers, and in the article I also discuss what you can do to lower elevated liver enzymes.  The name of the article is entitled “How To Decrease Liver Enzymes in Hyperthyroidism and Graves’ Disease“.

Precaution #3: Monitor your white blood cell count.  Agranulocytosis is a serious condition involving a severe lowering of the white blood cell (WBC) count, which is also known as leukopenia.  There are a few different drugs that can cause this condition, with one of them being antithyroid medications (1).  An absolute neutrophil count of <500/μl while taking antithyroid drugs establishes the diagnosis (2).

The way agranulocytosis is diagnosed is through a complete blood count (CBC) with differential.  This is also a good reason to obtain this test prior to being on antithyroid medication, and then again thereafter, as if someone has a normal WBC count prior to taking the meds but then it becomes depressed after being on the medication, then it’s highly likely that the medication is what caused the decrease.  In this case the antithyroid medication needs to be stopped.

Precaution #4: Don’t overexert yourself.  Although I’m in favor of people being active, those with hyperthyroidism shouldn’t overdo it.  The problem is that many people don’t realize that they are overexerting themselves.  This is especially true for those who exercise on a regular basis.  For example, prior to being diagnosed with Graves’ disease I was overtraining, but at the time I didn’t realize this.  And while I don’t think this was the sole reason why I developed Graves’ disease, overtraining causes dysregulation of the immune system and weakens the adrenals, and so without question it could have been a contributing factor.

Upon being diagnosed with hyperthyroidism I definitely took it easier, and the same is true with many of my patients.  But some people still work out too hard AFTER being diagnosed with hyperthyroidism.  While most people with hyperthyroidism are able to do some light walking and weightlifting while trying to restore their health, you should be cautious about engaging in activity that will significantly result in an increase in your heart rate.  This is true even for those who are taking antithyroid medication, beta blockers, and/or herbs (i.e. bugleweed, motherwort) to help lower the resting heart rate.

Precaution #5: Be aware of thyroid storm signs and symptoms.  Thyroid storm is a rare state of acute hyperthyroidism that can be life-threatening, and some of the potential triggers include trauma, myocardial infarction, surgery, an infection, and iodinated contrast medium (3).  This is especially a concern in cases of uncontrolled hyperthyroidism, such as someone who refuses to take antithyroid medication to manage their symptoms.  Some of the clinical manifestations of thyroid storm include fever, cardiac arrhythmias, vomiting, and impaired mental status (3).

If you are experiencing any of the symptoms I mentioned above it is critical to visit the nearest emergency room.  Treatment of thyroid storm usually involves decreasing the thyroid hormone levels with antithyroid medication and lowering the resting heart rate by taking beta blockers.  If someone is unable to tolerate antithyroid medication they might receive large amounts of potassium iodide to inhibit thyroid hormone production, or therapeutic plasma exchange (4).

Share These Precautions With Your Healthcare Practitioner

In addition to taking the precautions I mentioned in this blog post, I really do think it’s wise for those with hyperthyroidism to work with a competent natural healthcare professional.  Some may think I’m “tooting my own horn”, and while I do work with people who have hyperthyroidism and Graves’ disease, I’m not mentioning this here as a way to promote my practice.  The truth is that many functional medicine doctors are capable of helping people with Graves’ disease improve their immune system health.  However, besides the fact that not everyone with hyperthyroidism has Graves’ disease, many healthcare professionals are afraid to work with people who have hyperthyroidism.

This is one of the reasons why it’s much more common to see functional medicine practitioners who see people with hypothyroidism/Hashimoto’s.  Another reason is because more people have hypothyroidism than hyperthyroidism.  But the primary reason is because most healthcare practitioners are uncomfortable working with hyperthyroid patients.  This is also true with many endocrinologists, and is one of the reasons why they commonly recommend radioactive iodine and thyroid surgery to many of their hyperthyroid patients as the primary treatment option.  They feel that it’s easier (and safer) to manage hypothyroidism when compared to hyperthyroidism.

If you happen to be working with a chiropractor, naturopath, or a different healthcare practitioner who doesn’t have a lot of experience working with hyperthyroid conditions, I urge you to share this blog post with him or her.  Even if they tell you that they are comfortable with treating hyperthyroidism naturally, I’d still ask them to read this blog post so that they understand the importance of having their patients with hyperthyroidism take these precautions.  Because while it’s important to address the underlying cause of your condition, you want to be safe while taking a natural treatment approach.

Levothyroxine is one of the most commonly prescribed medications in the United States.  In fact, a few years ago synthetic thyroid hormone was THE MOST commonly prescribed medication, while in 2017 it was the second most popular prescription, followed by hydrocodone-acetaminophen (1).  While millions of people take synthetic thyroid hormone, more and more people are taking desiccated thyroid hormone (i.e. Armour, Nature-Throid, WP Thyroid).  Although many people need to take thyroid hormone replacement, there are also people who shouldn’t be taking it.  If you’re unsure whether or not you should be taking thyroid hormone replacement, hopefully you’ll have a better idea after reading this blog post.

Having healthy levels of thyroid hormone is essential.  But why is thyroid hormone so important?  Thyroid hormone not only plays an important role in metabolism, but it also regulates many bodily functions.  As I discussed in an article entitled “Why Is Thyroid Hormone So Important To Our Health“, thyroid hormone has some of the following roles:

• Thyroid hormone plays an important role in regulating gene expression
• Thyroid hormone plays a key role in brain development
• Thyroid hormone is important in the metabolism of proteins, carbohydrates, and lipids
• Thyroid hormone plays a role in peripheral nerve regeneration
• Thyroid hormones are required for optimal bone health
• Thyroid hormone plays a role in reproductive health

Overt Hypothyroidism vs. Subclinical Hypothyroidism

Overt hypothyroidism is when one or both thyroid hormone levels are below the lab reference range.  On the other hand, subclinical hypothyroidism is when the TSH is elevated, but the thyroid hormone levels are within the lab reference range.  The name “subclinical” can be misleading, as many people who are classified as having subclinical hypothyroidism are symptomatic, while others with subclinical hypothyroidism don’t experience any hypothyroid symptoms.

Subclinical hypothyroidism is considered to be mild when the TSH levels are between 4.0 and 10.0 mIU/l.  On the other hand, when the TSH is greater than 10.0 mIU/l it is considered to be severe.  This has limitations, as the TSH can fluctuate, and different labs will have different reference ranges.  It’s also important to understand that the severity of symptoms doesn’t always correlate with how high the TSH is.  For example, I’ve worked with patients who had a TSH greater than 10 mIU/l and didn’t feel too bad, but I’ve also consulted with patients whose TSH were within the lab reference range but felt lousy.

This brings up another discussion on the “lab” reference range vs. the “optimal” reference range.  For example, according to many functional medicine practitioners the “optimal” reference range for the TSH would be between 1 and 3 mIU/l.  But some labs don’t consider the TSH to be elevated unless if it is above 5.0 mIU/l.  The same concept applies with the thyroid hormone levels, as many people have thyroid hormone levels that are within the lab reference range, but are suboptimal.

What Causes Subclinical Hypothyroidism?

The most common cause of subclinical hypothyroidism is Hashimoto’s thyroiditis.  As discussed in other articles and blog posts, this is characterized by an elevated TSH and elevated TPO and/or thyroglobulin autoantibodies.  Other potential causes of subclinical hypothyroidism include a genetic polymorphism of the TSH receptor, transient TSH elevation during recovery from severe illness, untreated primary adrenal insufficiency, taking various drugs (i.e. lithium, amiodarone), and the presence of heterophile antibodies (2) (3).

What Are The Risks of Untreated Hypothyroidism?

If someone needs to take thyroid hormone replacement but chooses not to take it, what are the potential risks?  Well, one risk is that they might have to deal with symptoms that they wouldn’t otherwise experience if they were to take thyroid hormone.  I’ve worked with patients over the years who had moderate to severe hypothyroid symptoms but refused to take thyroid hormone replacement for various reasons.  But besides helping to decrease hypothyroid symptoms, remember that thyroid hormone has many important functions, as earlier I mentioned how it plays an important role in brain development, bone health, reproductive health, regulating gene expression, the metabolism of proteins, carbohydrates, and fats, and peripheral nerve regeneration.

In addition, there is some evidence that untreated subclinical hypothyroidism can increase the risk of developing cardiovascular disease.  In an article I wrote entitled “LDL Particles, Lipoprotein A, and Thyroid Health”, I discussed how having high LDL particles and lipoprotein a, which is also known as Lp(a), can increase one’s cardiovascular risk.  And having low thyroid hormone levels can lead to increases in LDL particles and Lp(a).  I also came across a study which showed that high blood pressure was more common in those with subclinical hypothyroidism, although a few studies showed that there wasn’t a reduction of blood pressure upon taking thyroid hormone replacement (4) (5).

If you are pregnant and have subclinical hypothyroidism then there is an even greater risk of not taking thyroid hormone.  Some studies have shown that pregnant women with mild subclinical hypothyroidism have an increased risk of gestational hypertension and pre-eclampsia (2).

What Are The Risks of Taking Thyroid Hormone Unnecessarily?

Perhaps the greatest risk of taking thyroid hormone replacement if you don’t need it is becoming hyperthyroid.  This can also occur if you need thyroid hormone replacement but take too high of a dosage.  For example, if someone has a mild case of subclinical hypothyroidism and they start with a dosage of 150mcg of levothyroxine, this very well might be too high.  But even if they had a severe case of subclinical hypothyroidism it probably would be wise to start with a lower dosage and gradually increase it.

Why Do Some People Who Need Thyroid Hormone Refuse To Take It?

There are a few reasons why people refuse to take thyroid hormone replacement, even if their blood tests indicate that they can benefit from it.  First of all, some people simply don’t think they need to take any type of exogenous hormone replacement.  While this is debatable if someone has subclinical hypothyroidism, if someone has overt hypothyroidism then there is a greater concern with not taking thyroid hormone.  Of course either way one needs to address the cause of the problem, and if someone has primary adrenal insufficiency that is causing overt hypothyroidism they need to address this first.  On the other hand, if someone has overt hypothyroidism that is caused by Hashimoto’s, although you still want to address the cause of the problem and restore the health of your immune system, while doing this it might be a good idea to take thyroid hormone replacement.

Another reason why some people don’t take thyroid hormone replacement is because they consider it to be a drug.  While it’s true that levothyroxine, as well as desiccated thyroid hormone, require a prescription, you shouldn’t put them in the same category as prescription drugs such as antibiotics, statins, acid blockers, etc.  The reason for this is because while people don’t have a deficiency of a statin or an acid blocker, they of course can have a deficiency of thyroid hormone.  I’m not trying to talk anyone into taking thyroid hormone, but if you truly need it but are avoiding it because you don’t want to take any “drugs”, I wouldn’t classify thyroid hormone as being a “drug”.

That being said, some forms of thyroid hormone replacement are superior to others.  For example, while a lot of people take Synthroid, this probably is the lowest quality form of thyroid hormone replacement available due to the fillers and artificial ingredients.  If you need to take synthetic T4 then consider a more hypoallergenic form such as Tirosint, or perhaps a more natural form such as Nature-Throid or WP Thyroid.

Another concern people have is that they will become dependent on thyroid hormone replacement.  In other words, once they start taking it they won’t be able to wean off of it.  The truth is that a “hormone dependency” can happen when taking any type of hormone, but I’ll also add that I’ve had many patients who were taking thyroid hormone replacement for many years prior to working with me who were able to wean off.  While it’s true that some people do need to remain on thyroid hormone replacement permanently, this isn’t the case with everyone.  And even if this were the case, you need to weigh the risks and benefits.

When Should You Take Thyroid Hormone Replacement?

Just in case you’re still unsure whether or not you should take thyroid hormone replacement, I’ll list a few situations when you will want to consider taking it.

1. If you have overt hypothyroidism.  If your thyroid hormone levels are below the lab reference range then you should strongly consider taking thyroid hormone replacement.

2. If you have a severe case of subclinical hypothyroidism.  Earlier I mentioned how the research considers a TSH greater than 10 mIU/ as being severe.  However, if someone in this situation has both thyroid hormone levels within the optimal reference range, then it is questionable if they should take thyroid hormone replacement.

3. If you have a mild case of subclinical hypothyroidism during pregnancy.  Of course the reasoning behind this is to decrease the risk of complications during pregnancy, as well as to reduce the risk of impaired cognitive development of the fetus.

4. If you have a mild case of subclinical hypothyroidism but experience severe hypothyroid symptoms.  This also is debatable, but I’ve had some patients who had a mildly elevated TSH and felt much better when taking thyroid hormone.

I’m not suggesting that there aren’t other scenarios when you would want to consider taking thyroid hormone replacement, but these are some of the situations when you should strongly consider taking it.

In summary, millions of people take thyroid hormone replacement.  And while there is a good argument that most people with overt hypothyroidism should take thyroid hormone, it’s more controversial when discussing whether people with subclinical hypothyroidism should take it.  Just as is the case with anything else, one needs to look at both the risks and benefits.  Some scenarios that might warrant someone with subclinical hypothyroidism taking thyroid hormone replacement are if their TSH is very high, if they are pregnant, and/or if they are very symptomatic.