Whether you have Graves’ disease or Hashimoto’s thyroiditis, the primary key to getting into remission is to find and remove your specific autoimmune triggers.  This can be very challenging to do, which is why it took so long to write my new book “Hashimoto’s Triggers” (which is now available on Amazon).  Speaking of which, even though the title of the book may imply that it’s specifically for those who have Hashimoto’s, the truth is that the process of detecting and removing triggers is similar regardless of whether someone has Hashimoto’s, Graves’ disease, or a different autoimmune condition (i.e. rheumatoid arthritis, multiple sclerosis, lupus, etc.).  So the truth is that this book can benefit those people with other autoimmune conditions, although some of the information is specific to Hashimoto’s.

But why can it be so challenging to find your autoimmune triggers?  While there are only 4 main categories of autoimmune triggers (food, stress, microbes, and chemicals), there are numerous triggers within each of these categories.  And while I mentioned in the opening paragraph that the process of detecting and removing triggers is similar regardless of the autoimmune condition someone has, different people will have different triggers.  In addition, it’s common to have multiple triggers.

Dealing With Multiple Autoimmune Triggers

For example, one person with an autoimmune condition might have gluten and an infection as triggers.  In this situation, removing gluten alone won’t always result in a significant improvement in the person’s symptoms and/or a reduction in their autoantibodies.  As a result, the person might end up eliminating gluten and not notice any improvement in their symptoms, and on top of this their autoantibodies remain elevated, and so they conclude that the problem isn’t with gluten.  Perhaps this person even had a negative celiac panel, and they don’t realize that it’s possible to have a gluten sensitivity, even in the absence of celiac disease (called a non-celiac gluten sensitivity).

This example shows why you can’t always rely on symptoms to detect your triggers.  Sure, there are some people who have experienced complete resolution of their symptoms and a normalization of their antibodies upon removing gluten, or upon following an autoimmune Paleo (AIP) diet.  But I don’t find these situations to be common in my patients.  Of course one reason for this is because many people make these dietary changes on their own, and some are able to find their food triggers without working with a natural healthcare professional.  On the other hand, other people aren’t able to successfully find and remove their autoimmune triggers.

In any case, the reason why I brought up this example is because if someone has multiple autoimmune triggers, then the obvious goal should be to remove all of them.  But sometimes not all of these triggers are detected initially, which is why you can’t conclude that food isn’t a trigger just because you don’t feel better upon eliminating it.  In the example I just gave, the person very well might have to eliminate gluten AND eradicate the infection before they see a significant improvement in their symptoms and/or a lowering of their thyroid antibodies.  On the other hand, others might experience significant symptomatic improvement just by eliminating gluten alone, even in the presence of one or more additional triggers.

How Much Testing Do You Need To Find Your Triggers?

In my book on Hashimoto’s Triggers, I talk about conservative vs. comprehensive testing.  Conservative testing involves doing some basic testing, and for many people this is sufficient to find their triggers.  On the other hand, some people need more comprehensive testing.  How can you determine if you need conservative or comprehensive testing?  Some people make this decision based on the costs of the tests, and while I can understand not wanting to spend a lot of money on testing, at the same time you also want to do what is necessary to find your triggers.

Does this mean that I’m in favor of comprehensive testing?  Not necessarily, as I actually prefer to take a conservative approach whenever possible, but if after conducting a thorough health history I feel that more comprehensive testing is necessary, then I’ll make this recommendation to the patient.  Of course regardless of whether a healthcare practitioner recommends conservative or comprehensive testing, it is ultimately up to you.  In other words, all a healthcare practitioner will do is give his or her recommendations, and then it’s up to you to decide how much testing you want to do.

I’ll also add that there are risks of doing either conservative or comprehensive testing.  For example, when I was diagnosed with Graves’ disease I personally didn’t do a lot of testing.  So I fell under the “conservative testing” category.  The risk with conservative testing is that you might not detect all of your triggers, and additional testing might be necessary in the future.  While some people are fine taking this approach, other people don’t want to take the chance.  In other words, some don’t want to rely on conservative testing, risk not finding all of their triggers, and then have to do additional testing a few months later.

Of course the “risk” with comprehensive testing is that you might end up spending money on testing that you don’t need.  For example, there are some healthcare professionals who recommend in excess of $1,000 worth of testing to all of their patients.  I’m not saying this is right or wrong, as everyone takes a different approach.  And while it can be beneficial to rule out certain triggers (i.e. infections), some people are on a very tight budget, and are therefore unable to spend a lot of money on testing.

Don’t Forget To Heal Your Gut!

Although the main focus of this blog post was to discuss triggers, it’s important to remember that while finding and removing your triggers is necessary to reverse the autoimmune component, you need a healthy gut in order to have a healthy immune system.  And according to the triad of autoimmunity, everyone with Graves’ disease and Hashimoto’s (and every other autoimmune condition) has a leaky gut.  And while in some cases finding and removing your triggers will be sufficient for gut healing, this isn’t always the case.

In my book I discuss the difference between “direct” triggers and “leaky” gut triggers, and while I won’t get into detail here about this, I will say that sometimes the direct trigger and the leaky gut trigger are the same, but at other times they can be different.  For example, the research shows that gluten can cause a leaky gut in everyone, and so gluten is a leaky gut trigger.  And while it can also be a direct trigger of autoimmunity, this isn’t the case with everyone.  Don’t get me wrong, as ideally everyone with an autoimmune condition should avoid gluten since it can cause a leaky gut, and according to the triad of autoimmunity, a leaky gut is a necessary component of autoimmunity.

Now I’d like to hear from you, as I’d like to know what you have specifically done to find your autoimmune triggers.  Please leave a comment below and let me know!

Note: by the way, for a limited time the electronic version of my book is available on Amazon for 99 cents.  In addition, for anyone who purchases either the electronic version or paperback version of my book I’m also offering 3 free bonus gifts.  For more information click here.

Last Friday I was on Facebook Live doing a presentation on testing the adrenals, but for those who prefer reading the information I’m giving a summary in this blog post.  I’ll be focusing on 3 different types of adrenal testing.  Although in the upcoming weeks a lot of the material will focus on Hashimoto’s thyroiditis to celebrate the release of my new book “Hashimoto’s Triggers”, which will be released on March 5^th, this information on adrenal testing will benefit those with hyperthyroidism and Graves’ Disease as well.

Why Should You Test The Adrenals?

When I was diagnosed with Graves’ Disease, I didn’t think stress was a factor.  I always considered myself to have good stress-handling skills, and so you can imagine how surprised I was when an adrenal saliva panel revealed that I had depressed cortisol levels and a depressed DHEA.  This was my first lesson on how you can’t go by symptoms when determining the state of your adrenals.  The pattern I had is referred to by many as an “adrenal fatigue” pattern, and while I can’t say that I felt awesome while I had Graves’ Disease, I can say that fatigue wasn’t one of my primary symptoms.

Some healthcare professionals don’t recommend adrenal testing because they assume that all people have adrenal imbalances.  I argue that this is a reason why everyone should do adrenal testing.  It would be one thing if everyone with an adrenal imbalance had the same pattern, but this isn’t the case.  As I mentioned earlier, when I was dealing with Graves’ Disease both my cortisol levels and DHEA were depressed.  However, many others will have elevated cortisol levels.  And while there is some overlap between treating someone with elevated cortisol levels when compared to depressed cortisol levels, the treatment isn’t exactly the same.

Healthy Adrenals Are Necessary For Healthy Sex Hormones

In the past I wrote a blog post entitled “The Negative Impact of the Pregnenolone Steal”.  The pregnenolone steal is also known as the cortisol steal, and what this means is that the body prioritizes the production of cortisol at the expense of the sex hormones.  As a result, someone who is dealing with prolonged chronic stress not only is likely to have an adrenal imbalance, but there is a very good chance that some or all of their sex hormones (i.e. progesterone, estrogen, testosterone) will be deficient.

In this scenario, many doctors who dispense bioidentical hormones would recommend these to the patient.  However, the real problem isn’t with the sex hormones, but instead is with the adrenals.  I’m not suggesting that all sex hormone deficiencies are due to adrenal imbalances, but the truth is that the majority of sex hormone imbalances can be corrected by improving the health of the adrenals.

Can You Take Adrenal Supplements Without Doing Any Testing?

Even though I’m discussing the importance of adrenal testing in this blog post, the truth is that many people take adrenal support supplements without doing any testing.  For example, I commonly see people randomly taking adaptogenic herbs such as ashwagandha, rhodiola, and eleuthero.  Others will take nutrients such as vitamin C and the B vitamins to support the adrenals.  And while taking these without testing might not do you any harm, you want to be cautious about taking other supplements without knowing what type of adrenal imbalance you have.

For example, if you have elevated cortisol levels then you wouldn’t want to take licorice root or an adrenal glandular, as these are best taken when someone has depressed cortisol levels.  Similarly, phosphatidylserine is best taken if someone has elevated cortisol levels.  And while I don’t commonly recommend DHEA to my patients, when I do recommend it I’ll make sure that the person has low DHEA levels.  This might sound like common sense to some people reading this, but you’d be surprised how many people I’ve seen over the years who were taking supplements and/or hormones that didn’t fit their adrenal pattern.

While I’d be cautious about taking adrenal supplements without any testing, anyone can of course incorporate lifestyle changes to help improve their adrenal health.  In fact, in order to have optimal adrenal health it is necessary to eat well, do a good job of managing stress, and to get sufficient sleep.  These are factors that everyone can and should work on.  In fact, working on these diet and lifestyle factors is even more important than taking supplements.

3 Types of Adrenal Testing

What I’d like to do next is discuss three different ways to test for the adrenals:

1. Blood Testing.  Many medical doctors, including just about all endocrinologists, never do any adrenal testing.  The exception is if they suspect that someone has adrenal insufficiency in the form of Addison’s disease or Cushing’s syndrome.  Those medical doctors who do test the adrenals usually utilize blood testing.  In most cases they will order a morning cortisol, and perhaps test the DHEA.

Adrenocorticotropic hormone (ACTH) is a pituitary hormone that can also be tested for in the blood.  It stimulates cortisol production, and if someone has a condition such as Addison’s disease they will usually see depressed cortisol and increased ACTH, while with Cushing’s syndrome, both cortisol and ACTH will usually be increased.  An adrenal tumor frequently presents with increased cortisol levels and a decreased ACTH.

While blood testing isn’t completely useless, there are a few reasons why you shouldn’t rely on this type of testing for determining the health of the adrenals.  First of all, blood testing doesn’t look at the circadian rhythm of cortisol, and the reason for this is because this almost always involves a single blood sample.  As I’ve discussed in past blog posts and articles, cortisol follows a circadian rhythm, as it should be at the highest level in the morning, and gradually decrease throughout the day.  While someone can conceivably visit a lab multiple times in a single day to see what cortisol looks like at different times, this a major inconvenience, which is one of the main reasons why it usually isn’t done.

In addition, false elevations of cortisol are common in the blood.  One of the main reasons for this is because it’s common for people to get stressed out when getting a blood draw.  And cortisol increases when someone is in a stressed out state.

One advantage of blood testing is that you can test for anti-adrenal antibodies.  An example is 21-hydroxylase antibodies.  I can’t say that I have most people test for this, and even though I once had depressed cortisol levels I personally didn’t test for these antibodies.  But if someone has low cortisol levels that remain depressed over a prolonged period of time, then in this situation it would be a good idea to test these antibodies, as this might be suggestive of Addison’s disease.

2. Adrenal Saliva Testing.  I’ve been recommending adrenal saliva testing to my patients for many years.  The main reason I started using saliva testing in my practice is because of the success I personally had with saliva testing when I was diagnosed with Graves’ Disease.  And over the years I have also seen many of my patients benefit from saliva testing.  There are a few reasons why saliva testing is a good option for evaluating the adrenals.  Let’s take a look at three of these reasons:

• Saliva testing looks at the circadian rhythm of cortisol
• Saliva testing is less invasive than blood testing
• Saliva testing is just as accurate as blood testing

Just as is the case with blood testing, false elevations of salivary cortisol are possible.  Cortisol responds to stress, and so for example, if someone is in a stressed out state prior to collecting the saliva sample, then there is a good chance this will cause an elevation of cortisol.  Based on what I just said, you might assume that it’s best to do cortisol testing in a relaxed state.  And many of my patients do collect their saliva samples on an off-day from work due to this reason.  However, one can argue that it might be best to test your adrenals under “normal” conditions, which means that if you are stressed out Monday through Friday due to work, but are relaxed on the weekend, then perhaps it’s best to try to test the adrenals during the week.  So for example, you can collect a saliva sample upon waking up, another sample during your lunch break at work, another one when you come home for dinner, and then one right before going to bed.

I realize that for some people this isn’t practical, and truth to be told, even for those who collect the saliva samples on a more relaxed day it can still provide some valuable information.  And as I mentioned earlier, it’s very common for my patients to collect their saliva samples on their off days from work.  Either way, you definitely don’t want to collect the saliva samples under abnormally stressful conditions, as this is likely to result in false elevations of cortisol.

It’s also worth mentioning that many saliva panels test for more than the cortisol and DHEA.  The Adrenal Stress Index test from the lab I use also tests for 17-OH progesterone and secretory IgA.  You can also test for the sex hormones through the saliva, and cycling women can choose to do a cycling hormone panel.  This involves collecting a saliva sample every few days of one’s cycle, which not surprisingly gives more information than a single blood test taken in the second half of the cycle.

3. Dried Urine Testing.  In 2017 I started “experimenting” with dried urine testing.  A lot of well known healthcare professionals (i.e. Dr. Joseph Mercola) recommend this type of testing.  I used myself as a guinea pig initially, and I was impressed with what I saw, which is why I started recommending it to some of my patients.  This test involves urinating on test strips throughout the day, which like the saliva, allows you to look at the circadian rhythm of cortisol.  It also tests the sex hormones, but unlike saliva testing, dried urine testing can also look at the “hormone metabolites”, which in some cases can be helpful.

While there can be some value in looking at cortisol metabolism through dried urine testing, perhaps the most important metabolites to evaluate are the estrogen metabolites.  These include 2-hydroxyestrone (2-OH), 4-hydroxyestrone (4-OH), and 16α-hydroxyestrone (16α -OH).  The reason why looking at these metabolites can be important is because having higher levels of 4-OH metabolites can potentially be a risk factor for developing certain types of cancer, while having higher levels of 2-OH metabolites can be protective.

Which Type of Testing Should You Do?

Now that you are familiar with the different ways to test for the adrenals, you might be wondering what the best test is for you.  As of now I still recommend adrenal saliva testing to most of my patients.  However, if someone wants to test for both the adrenals and sex hormones then either saliva testing or dried urine testing can be a good option.  Dried urine testing is more comprehensive in that it also tests for the hormone metabolites. For cycling women, both saliva testing and dried urine testing offer cycling hormone panels.

In summary, I recommend adrenal testing to just about all of my patients, and the reason for this is because most people have adrenal imbalances, and people will present with different adrenal patterns.  I have primarily used saliva testing in my practice over the years, although recently I started using dried urine testing on some of my patients.  If someone is just interested in evaluating the adrenals then I think it’s fine to use saliva testing, and while I have also used saliva testing to evaluate the sex hormones in the past, dried urine testing has the advantage of looking at the hormone metabolites.  Blood testing usually should be utilized when more serious adrenal problems are suspected, including Addison’s disease, Cushing’s syndrome, or an adrenal tumor.

Hashimoto’s Triggers Book Update: I just wanted to remind you that my new book on Hashimoto’s Triggers will be released on Monday, March 5^th.  It will be available in both paperback and Kindle format, and the first few days after its release I will be offering a special discount on the Kindle version, along with a few free bonus gifts for anyone who purchases either the paperback version or the Kindle version.  If you would like to check out a free chapter of my book you can do so by clicking here.

Last Friday I spoke on Facebook Live about food triggers and Hashimoto’s.  I thought the presentation went well, but I decided to put together a different presentation on the same topic.  You can watch the video by clicking here, or if you prefer to read the information I also will give a summary in this blog post.  By the way, I plan on appearing on Facebook live every Friday at 1:30pm EST up until the release of my new book, and then even after the release I hope to continue doing them on a regular basis.  Although I’ll be focusing on Hashimoto’s the next few weeks due to my book release, a lot of the information discussed will also benefit those who have Graves’ Disease.

For those who prefer to read rather than watch videos, here is a summary of what I discussed in the video:

I started off by talking about the triad of autoimmunity, which involves 1) a genetic predisposition, 2) an environmental trigger, and 3) an increase in intestinal permeability, which is also known as a leaky gut.  I then briefly mentioned a few of the common triggers of Hashimoto’s.  Besides food allergens such as gluten and dairy, other common triggers include stress, infections, and environmental toxins.  In my upcoming book “Hashimoto’s Triggers” I discuss all of the different triggers in detail, along with how to detect and remove your specific triggers.

Why Is Food A Trigger In Some People?

I then briefly explained the difference between IgE food allergies and IgG food sensitivities.  IgE allergies usually elicit an immediate response, whereas food sensitivities don’t always produce symptoms, and when symptoms do appear they can sometimes take place a few days after eating the food you’re sensitive to.  I also mentioned how having an IgE allergy or IgG food sensitivity doesn’t necessarily mean this food is a direct trigger of your autoimmune thyroid condition.

For example, some people have an IgE peanut allergy, but this doesn’t mean that this is the trigger in someone with Hashimoto’s.  In fact, in all likelihood the person with such an allergy will avoid peanuts.  As for food sensitivities, just because you’re sensitive to a certain food also doesn’t mean it’s an autoimmune trigger.  For example, I just consulted with someone who has digestive symptoms whenever she eats Brussels sprouts.  This doesn’t mean that Brussels sprouts are a direct trigger in her situation, although if she has a sensitivity to Brussels sprouts and continues to eat them, this probably will cause gut inflammation, and thus it would be a good idea to avoid this food.

I briefly spoke about molecular mimicry and food triggers.  According to one theory, gliadin has an amino acid sequence that resembles the thyroid gland, which in turn causes the immune system to attack it.  And so essentially this is a case of mistaken identity, as the immune system attacks the thyroid gland because it looks like gluten.  I do want to add that as of now this is still a theory, although in the research there is a molecular mimicry mechanism involving certain pathogens.

Food Isn’t a Trigger In Everyone

I then spoke about how food isn’t a trigger in everyone with Hashimoto’s, and this is one reason why some people don’t feel better when eliminating common allergens such as gluten.  This is also a reason why some people don’t feel better when following an autoimmune Paleo diet.  However, I also mentioned how the lack of symptoms when eating certain foods doesn’t mean it’s not a trigger.  I discussed how when gluten isn’t a “direct” trigger it can cause a leaky gut.  In fact, there is strong evidence that gluten causes a leaky gut in everyone.

I then discussed “direct” triggers vs. “leaky gut” triggers.  This is discussed further in my book on Hashimoto’s.  I also mentioned how it’s possible to have multiple triggers.  In fact, I will add that it’s common to have more than one trigger.

The Problem With Gluten, Dairy, and Corn

I’ve spoken about gluten in numerous other blog posts, and during this presentation I spent a few minutes on this.  I started by discussing how many people are sensitive to gluten.  I then differentiated between celiac disease and a non-celiac gluten sensitivity.  In both cases you ideally want to avoid gluten on a permanent basis, and if you test for gluten, please keep in mind that you need to be eating gluten for the test to be positive.  And the reason for this is because if you don’t eat gluten, your body won’t produce antibodies to the proteins of gluten, even if you have a gluten sensitivity.  I then reinforced how the research shows that gluten causes a leaky gut in everyone.

Some question whether the problem isn’t with gluten or wheat, but instead is with glyphosate.  I dedicated an entire chapter to glyphosate in my book, and while this is a big problem, the truth is that both gluten and glyphosate are problematic.  Sure, there might be some cases where someone is reacting more to the glyphosate than the gluten, and vice versa.

Dairy is another common allergen, and it also cross-reacts with gluten.  In other words, consuming dairy products can lead to the production of gliadin antibodies.  And while some people do fine eating healthier forms of dairy (i.e. raw dairy), this isn’t the case with everyone.  In other words, some people have problems with dairy, regardless of the source.

Let’s not forget about corn, as this also is a common allergen, and, like dairy, corn also cross-reacts with gluten.  In addition, most corn is genetically modified.  There of course are other food allergens, and in my book I discuss food triggers in much greater detail.

Should You Follow An Autoimmune Paleo Diet?

I also have had plenty of articles and blog posts that focused on an autoimmune Paleo (AIP) diet.  In the video I explained the difference between an AIP diet and a “standard” Paleo diet, and if you want to learn more about this you can either watch the video or read a blog post I wrote entitled “Should Everyone With Graves’ Disease and Hashimoto’s Thyroiditis Follow an Autoimmune Paleo Diet?“.  But essentially an AIP diet eliminates the most common allergens AND foods that can interfere with gut healing.

As for who should follow an AIP diet, in the video I mentioned two specific categories:

Category #1: Those with an autoimmune condition.  This not only includes those with Hashimoto’s, but Graves’ Disease and other autoimmune conditions as well.

Category #2: Anyone who has a leaky gut.  As I mentioned earlier when discussing the triad of autoimmunity, everyone with an autoimmune condition has a leaky gut.  However, it of course is also possible to have a leaky gut in the absence of an autoimmune condition.

How long should someone with Hashimoto’s (or a different autoimmune condition) follow an AIP diet for?  I recommend to follow an AIP diet for at least 30 days, and if someone is thriving after 30 days then it makes sense for them to continue following it for a few additional months.  On the other hand, if they don’t feel better and are struggling with the diet then I’m open to them reintroducing some of the excluded foods.

I finished up the video by listing the following action steps you can take:

• Consider avoiding gluten, dairy, and corn
• Avoid refined foods and sugars
• If you want to go a step further, follow an AIP diet for at least 30 days
• Also try to avoid genetically modified foods
• Reminder: a lack of symptoms when eating a certain food doesn’t mean it’s fine to eat that food
• Should you consider food sensitivity testing?
• Many times following an elimination/reintroduction diet can help identify foods you’re reacting to

Most of these are self-explanatory, although if you read through these steps you might wonder what my thoughts are on food sensitivity testing.  I’m definitely not opposed to such testing, although I will say that most of my patients don’t obtain this type of testing.  And the main reason for this is because false results are common.  I usually recommend an elimination diet to my patients, and while I’ve written about both the elimination diet and food sensitivity testing in past blog posts, I go deeper in my book.

That essentially is a summary of the video.  Speaking of which, I hope you found this information to be valuable.  If so please let me know in the comments below, and if the feedback is positive I’ll try to write a summary with future videos as well.  I realize that while some people love watching videos, others prefer reading information, and so I think it would be a good idea to do both.  But of course what I think doesn’t matter, as my goal is to serve you, which is why I want to get your opinion.

One thing that was in the video that I didn’t mention here (until now) was the opportunity to get a free chapter of my book, Hashimoto’s Triggers.  You can get this chapter by clicking here.

Most people with Hashimoto’s thyroiditis are told to take thyroid hormone replacement, and nothing is ever done to address the cause of the problem.  Endocrinologists know that Hashimoto’s is an immune system condition, but we need to keep in mind that they aren’t immune system specialists.  This is one reason why they don’t do anything to improve the health of your immune system.  But the main reason why endocrinologists ignore the immune system is because they simply aren’t trained in medical school to address the cause of Hashimoto’s.

For someone who does well on thyroid hormone this might not seem like a concern, and the truth is that many people who are diagnosed with Hashimoto’s simply follow the advice of their medical doctor.  And for those reading this who are taking thyroid hormone replacement due to the advice of an endocrinologist, or another type of medical doctor, I’m not suggesting that you shouldn’t take it.  But I am here to say that there are risks of taking thyroid hormone without improving the health of your immune system.  Here are two of these risks:

Risk #1: Many people take Synthroid, which has numerous fillers, as well as artificial ingredients.  While I’m not opposed to someone taking synthetic thyroid hormone, there are better options available than Synthroid.  An example is Tirosint, which is a hypoallergenic form of synthetic T4.  Taking natural desiccated thyroid such as Armour, Nature-Throid, or WP Thyroid is also something to consider, as many people do better on these than synthetic thyroid hormone.

I realize that Synthroid is probably a less expensive option, and perhaps even covered by your health insurance, but we all know that you usually get what you pay for.  For example, purchasing organic food is more expensive than non-organic food, but the reason why many people are willing to pay extra money for organic food is to minimize their exposure to the chemicals that are present in non-organic food.  One problem is that many people who take Synthroid don’t read the ingredients, while others don’t realize that there are hypoallergenic forms of synthetic thyroid hormone available (for those who can’t take or prefer not to take desiccated thyroid).

Risk #2: People with Hashimoto’s have an increased risk of developing other autoimmune conditions in the future.  This is in the research, and it’s a big reason why EVERYONE with Hashimoto’s needs to be proactive and try to detect and remove their autoimmune triggers.  While nobody wants to be diagnosed with Hashimoto’s, and some people with this condition have extreme fatigue, brain fog, and other symptoms, keep in mind that some other autoimmune conditions are arguably worse to have.  For example, while many people are able to function normally when taking thyroid hormone, this might not be the case for someone who has been diagnosed with multiple sclerosis, rheumatoid arthritis, or other autoimmune conditions.

Just to be clear, I’m not advising anyone to stop taking their thyroid hormone replacement.  But for those who do this without improving their immune system health, you are at risk of developing other autoimmune conditions in the future.

What Does It Mean To “Reverse” Hashimoto’s?

The headline of this blog post is “Can Hashimoto’s Be Reversed?”  The answer to this question is “yes”, it is possible to reverse Hashimoto’s.  But what exactly does this mean?  Well, when I use the word “reverse” I’m suggesting that the autoimmune component can be reversed.  In other words, it’s possible to detect and remove the autoimmune triggers and normalize the thyroid antibodies.  I’m not suggesting that this is easy to accomplish, as without question some cases of Hashimoto’s are more challenging than others.  And then even when the autoimmune component has been reversed, for some people it is challenging to maintain a state of remission.

This is true with all autoimmune conditions.  As many reading this know, I was diagnosed with Graves’ Disease in the past, and I have been in remission since 2009.  Since then, I have helped many people with Graves’ Disease and Hashimoto’s achieve a state of remission.  The primary key to helping people with these autoimmune thyroid conditions achieve a state of remission is to find and remove the person’s triggers.  I’ve written about this in past articles and blog posts, have conducted webinars on this topic, and soon I will be releasing a new book that focuses on helping you find and remove your specific autoimmune triggers.

Yes, I know there are currently books on Hashimoto’s that focus on natural treatment methods.  In fact, I’m friends with many of the authors of these books.  But I promise you that my upcoming book is going to be the most comprehensive book to date with regards to discussing the different triggers of Hashimoto’s, along with helping those with this condition detect and remove their triggers.

As for when the book will be released, I don’t have an exact date yet, but I’m 99% certain that it will be released in the first quarter of this year.  In fact, the editing process has been completed, and it’s now in the hands of the formatter.  I’ll add that the first week it’s released there will be a huge discount, along with a few special bonuses for those who purchase the book.  In a couple of weeks I’ll have another update, and I’ll also include a copy of the cover.

In past articles and blog posts I have discussed some of the different conventional medical treatment options for hyperthyroid conditions, but I haven’t discussed something called block and replace therapy.  One of the main reasons for this is because this is rarely recommended to those with hyperthyroidism and Graves’ Disease, although every now and then I’ll work with someone who was recommended to receive this treatment by their endocrinologist.  As a result, I figured it was time to put together a brief post on this topic.

So what exactly is block and replace therapy?  Well, many people with hyperthyroid conditions are told to take antithyroid medication, which includes Methimazole, Carbimazole, and PTU.  These are given to “block” the production of thyroid hormone, and antithyroid medication accomplishes this by inhibiting an enzyme called thyroid peroxidase.  What it specifically does is inhibit the metabolism of iodide and the iodination of tyrosine residues in the thyroid hormone precursor thyroglobulin by thyroid peroxidase (1).

One problem with antithyroid medication is that people who take it commonly become hypothyroid.  So for example, it’s common for someone with elevated thyroid hormone levels to get a prescription for antithyroid medication, and when doing a follow-up thyroid panel their thyroid hormone levels will be low, while their TSH will be on the high side.  When this is the case, the medical doctor will usually lower the dosage of antithyroid medication and hope that the next thyroid panel will show a lower TSH and higher thyroid hormone levels, but at the same time prevent the person from becoming hyperthyroid again.

The “Seesaw” Effect of Antithyroid Medication

Sometimes this can become a frustrating process for the patient, as I’ve worked with people who were told to take a higher dosage of antithyroid medication, and then when the thyroid panel revealed a hypothyroid state the dosage was greatly reduced, and in some cases the patient was told to stop taking the Methimazole, and the person became hyperthyroid again.  So for example, a person with Graves’ Disease or toxic multinodular goiter might be told to take 40mg of Methimazole, and the next thyroid panel presents with hypothyroid numbers (elevated TSH and low thyroid hormone levels), and so the person’s dosage is reduced to 10mg, only to have the person become hyperthyroid again.

With block and replace therapy, the person isn’t only put on antithyroid medication to “block” the production of thyroid hormone, but they are also given thyroid hormone replacement (i.e. levothyroxine).  So it’s almost like a balancing act, as the antithyroid medication will prevent the person from becoming hyperthyroid, but the person is also given some thyroid hormone to prevent them from becoming hypothyroid.  Block and replace therapy is usually reserved for moderate to severe cases of hyperthyroidism, as with this treatment higher doses of antithyroid medication are usually taken by the patient.

Why Is Block and Replace Therapy Seldom Used?

Rarely does an endocrinologist in the United States recommend block and replace therapy, and it also isn’t commonly recommended by medical doctors in other countries.  One reason for this is because the relapse rates are comparable to someone who is taking antithyroid medication alone, but another reason is because side effects seem to be more common with block and replace therapy (2).  Another thing to keep in mind is that most endocrinologists are far more concerned about managing hyperthyroidism, which is why many will recommend radioactive iodine or thyroid surgery as the first line of treatment.  In other words, many aren’t concerned if their hyperthyroid patients become hypothyroid by taking antithyroid medication.

This doesn’t mean that there aren’t times when block and replace therapy can be beneficial.  For example, pregnant women with hyperthyroidism are usually told to take antithyroid medication.  While many people are understandably concerned about the effects of these medications on the liver, another concern during pregnancy is that antithyroid medication can lead to hypothyroidism.  And of course thyroid hormone is very important for the developing fetus.  Block and replace therapy during pregnancy was discussed in a case study involving a 36-year old woman, as the authors explained how it is challenging to keep the free T4 in the upper range of normal with antithyroid medication alone, and that block and replace therapy can prevent fetal hypothyroidism from developing (3).

Graves’ orbitopathy might be another situation where block and replace therapy is indicated, as a study showed that using long-term block and replacement therapy until Graves’ orbitopathy becomes inactive might be a good option (4).  One thing to keep in mind was that the patients in this study were treated with block and replace therapy for an average of 41 months, and many endocrinologists would refuse to have their patients take antithyroid medication for that long, even if the liver enzymes were fine during treatment.

The truth is that block and replace therapy might be beneficial in certain situations, but most endocrinologists are trained to prescribe antithyroid medication alone, which is why they commonly recommend this to their patients with hyperthyroidism and Graves’ Disease.  In fact, some endocrinologists aren’t even familiar with block and replace therapy, and one reason for this is because only a small percentage of their patients have hyperthyroidism and Graves’ Disease.  It is far more common for endocrinologists to deal with patients who have Hashimoto’s thyroiditis.  As a result, those with a hyperthyroid condition can expect to be advised to take antithyroid medication by their endocrinologist, or to receive radioactive iodine or thyroid surgery.

In summary, block and replace therapy involves taking both antithyroid medication and thyroid hormone.  So essentially the goal is to block the production of thyroid hormone, but at the same time have the patient take thyroid hormone replacement to prevent them from becoming hypothyroid.  Block and replace therapy is rarely recommended by endocrinologists, and two reasons for this are because 1) the relapse rate is comparable to taking antithyroid medication alone, and 2) side effects are more common.  However, pregnancy and Graves’ orbitopathy are two situations when this type of treatment might offer some benefits.