Part of the challenges of being a healthcare professional is determining which tests a patient actually needs.  When someone is suspected of having a thyroid or autoimmune thyroid condition, then certain tests obviously should be performed, such as a thyroid panel.  Other serum tests can also be valuable, such as a CBC with differential, a complete metabolic profile, a lipid panel, and a test for 25-OH vitamin D.  Most healthcare professionals would agree that these tests are valuable, but from this point on there is a dramatic difference in opinions with regards to which tests are necessary.

For example, many medical doctors will only recommend the blood tests I listed above, and won’t order additional tests.  In fact, some medical doctors will only order a thyroid panel, and won’t order other serum tests.  In my opinion EVERYONE should obtain the tests I listed above.  And of course if someone already has a chronic health condition such as Graves’ Disease or Hashimoto’s Thyroiditis, then they probably will need some of these tests measured on a frequent basis.

Is There An Overreliance of Tests By Natural Healthcare Professionals?

While some will argue that many medical doctors don’t do enough testing, others feel that some healthcare professionals do too much testing.  Other than the serum blood tests recommended by most other doctors, I usually recommend a few other tests, most commonly saliva testing and the “controversial” hair mineral analysis test.  There are times when I will recommend other types of testing, but these are the most common ones I recommend to my patients.  Some natural healthcare professionals will recommend much more testing than this, and sometimes it can run the patient thousands of dollars for the tests.

The goal of this post isn’t to criticize other healthcare professionals for recommending too many tests.  After all, I’m sure some might accuse myself of doing too much testing, although I personally don’t feel this is the case.  I’ve had a few people tell me that a competent healthcare professional shouldn’t rely on using tests, but instead should rely more on their diagnostic skills.  I agree that it’s important to have good diagnostic skills, as one needs to not only be able to take a good case history, but they also need to do a good job of interpreting the information, as well as evaluating the patient’s signs and symptoms.  However, when trying to find out the cause of a person’s thyroid or autoimmune thyroid condition, many times more information is required.  So in my opinion, a combination of good diagnostic skills and the appropriate testing is required to find out what the cause of the condition is.

This of course is easier said than done, as different healthcare professionals will have different opinions with regards to which tests are “appropriate”.  As I mentioned earlier, I usually recommend saliva testing and a hair mineral analysis test to my patients.  Some healthcare professionals laugh at the thought of using a hair mineral analysis, yet use other “controversial” methods of testing, such as food intolerance testing or micronutrient testing, both of which are also controversial, and are also very expensive.  Obviously each natural healthcare professional will have their own personal biases with regards to testing, and the most important factor is the results one receives with their patients.  I know numerous healthcare professionals who utilizing testing which is controversial, yet they receive excellent results with their patients.  For example, even though I don’t routinely do food intolerance testing, I know some healthcare professionals who routinely recommend this type of testing with their patients and receive excellent results.  And of course I wouldn’t recommend hair mineral analysis testing if I didn’t think it had some value in helping my patients restore their health.

What Are The Limitations Of The Different Tests?

What I’d like to do is take a look at some of the different types of tests and discuss some of their limitations.

Salivary cortisol testing. I recommend for just about all of my patients to do saliva testing to measure the cortisol levels throughout the day.  I also commonly test for other things through the saliva, but the focus here will be on the cortisol levels.  I find the cortisol testing to be accurate, meaning that when I test someone initially and find the cortisol levels to be elevated or depressed, frequently on a follow-up test I see the cortisol levels improve.  Of course this isn’t the case with everyone, and when someone isn’t showing improvement then we want to find out the reason why.

One of the most important factors to consider when measuring saliva cortisol levels is that cortisol responds to stress.  When someone has chronic stress, cortisol will become elevated for quite some time, sometimes for many years.  As the adrenals weaken over time the cortisol levels will become depressed, along with the DHEA levels.  However, “abnormal” stress can have a negative effect on such testing.  For example, if someone is collecting the saliva samples and gets into an argument with someone on the day of collecting the samples, there is a good chance this will result in a false elevation of cortisol levels, and will therefore lead to an inaccurate result.  Similarly, if someone is collecting the samples and has a migraine, this will also lead to a false elevation of cortisol.

As a result, it’s important to collect the saliva samples on a “normal” day.  Now when I say “normal”, keep in mind I’m not suggesting that you have to wait for a stress free day.  If this were the case then most of my patients would never be able to collect the samples.  If someone’s day is normally very stressful, then it’s fine to collect the saliva samples on this day.  On the other hand, if there is an unusual amount of stress then it’s best to not collect the saliva samples, and if you have already started to collect the samples on this abnormally stressful day then it’s best to start over.

By the way, even though I’m focusing on “salivary” cortisol testing, this also applies to serum cortisol.  For example, some people will get a one-sample serum cortisol test done at the doctor’s office, and because they get stressed out when they visit the doctor this will falsely elevate their cortisol levels.  Some will even get stressed out when receiving the injection to get the blood drawn, which once again can elevate the cortisol levels, thus leading to false results.

Obviously taking cortisol will affect the results of the testing.  And even certain nutrients can affect the results, which is why when collecting a saliva sample you always want to carefully read the instructions which come with the collection kit.  Saliva testing can provide some wonderful information, although hopefully you now understand some of the potential drawbacks of such testing as well.

Hair mineral analysis. This is another test I commonly recommend to my patients.  And I admit that it is a very controversial test, and if you are relying on a hair mineral analysis test to tell you about all of the minerals and whether you are sufficient or deficient in them, you will be disappointed.  The truth is that the hair mineral analysis can be a wonderful, low cost method of looking at certain mineral imbalances, as well as heavy metal toxicities.  However, there definitely are some limitations as well.

For example, most hair analysis companies will test for the mineral iron.  The problem is that you can’t rely on the hair mineral analysis when it comes to evaluating the iron levels.  Many times I find the iron to be low on a hair mineral analysis test, yet on an iron panel consisting of serum iron, ferritin, and iron saturation, everything is well within the normal limits.  In other words, these values are well with the “functional” reference range on a serum iron panel, yet iron might look completely depleted on a hair mineral analysis.  And iron is one of those minerals that you don’t want to take if you don’t need it.  Copper is another mineral which might appear as low on a hair mineral analysis test, but the person might not be deficient, and in some cases they might actually have a copper toxicity.  As a result, when interpreting copper in the hair  you want to look at some of the other values, such as zinc and calcium.  Just keep in mind that some of the minerals on a hair mineral analysis can appear to be low, but they might be biounavailable.

Another drawback of a hair mineral analysis is that certain external factors can cause a false elevation of the minerals.  For example, if someone has a water softener, then this can spike up the sodium levels on a hair mineral analysis.  As a result, if someone has a water softener then they will want to wash their hair in an alternative source (i.e. distilled water) for at least a few days before collecting the hair sample.  If someone is using a shampoo for dandruff, which commonly is high in selenium sulfide, this will mostly likely elevate the selenium levels.  Using pubic hair can elevate the phosphorus levels.

You might wonder why you can’t just do serum testing to look at the minerals.  Well, the problem is that serum testing isn’t completely accurate for most minerals.  And one reason for this is that with some of the minerals, the body will do everything it can to keep the minerals at a normal level.  For example, serum calcium will almost always be normal, even if someone has a calcium deficiency.  And the same is true with magnesium, along with some of the other minerals.  In any case, the hair mineral analysis isn’t perfect, but if someone takes the proper precautions (i.e. doesn’t wash their hair with a water softener or use dandruff shampoos), AND if the healthcare professional knows how to interpret it correctly, then it could be a very valuable tool.

Heavy Metal Testing. In addition to looking at the minerals, I also use the hair mineral analysis test to look at the toxic metals, such as aluminum, mercury, cadmium, arsenic, and lead.  One can also use urine and serum testing to look at toxic metals.  Serum tests are usually good for detecting acute heavy metal exposure, whereas both hair and urine are used for testing heavy metals that are stored in the tissues.  Although I think both urine testing and hair testing has value, the limitations of these tests is that they won’t reveal everything, as there will be always toxic metals stored in the tissues on the body which don’t show up on these tests.  Plus, when it comes to testing for mercury, the hair does a better job of testing for organic mercury, also known as methylmercury.  This type of mercury is more commonly found in fish.  On the other hand, urine testing for toxic metals is more accurate for determining levels of inorganic mercury, which is the type found in dental amalgams.  Thiomersal, which is still used in some vaccines, is a form of organic mercury.  Keep in mind that inorganic mercury is converted to organic mercury, and is considered to be more toxic than organic mercury.

Food intolerance testing. I know many healthcare professionals who require all of their patients to order a food intolerance panel.  In fact, when I was still in chiropractic school I had one of these done for the first time, and if I recall correctly I think I spent about $600 for this test.  There are different variations of these panels, as the most commonly recommended food intolerance panels utilize IgG testing.  Another common test is called the ALCAT”, which utilizes a different technology that involves something called the “Coulter” method, which involves “measuring white blood cells using the electronic principle of particle counting and sizing”.

Keep in mind that I have nothing against food intolerance testing.  In fact, if I knew for certain that such testing would be accurate I would recommend this type of testing to all of my patients.  After all, if there was a way to detect all of the food allergies and intolerances in a person that would be wonderful.  However, false results are very common with these tests.  This is especially true if someone has an increase in intestinal permeability (a leaky gut).  But even for those who don’t have a leaky gut, I can’t justify having my patients spend hundreds of dollars on a test which is likely to provide false results.

Once again, I’m not suggesting that these tests are completely inaccurate.  I’ve known some people who have obtained such testing and agreed with the positive findings.  In other words, upon eliminating the foods which came out positive on the food intolerance test they noticed an improvement in their symptoms.  However, false negatives are common, and so there is a decent chance of the person testing positive for certain foods, which might be accurate, yet they might have some false negatives.  And so what of course will happen in this scenario is that the person will avoid the foods they test positive for, but they will continue eating some foods which they might be sensitive to, yet didn’t show up as being positive on the test.

And as I mentioned earlier, having a leaky gut can completely throw off the results of the test.  Dr. Natasha Campbell McBride, who developed the GAPS diet, discusses this.  Here is what she has to say about leaky gut and food intolerances: “The reason for allergies and food intolerances is so-called ‘leaky gut’ when the gut lining is damaged by abnormal micro flora. Foods do not get the chance to be digested properly before they get absorbed through this damaged wall and cause the immune system to react to them. Many people try to identify, which foods they react to. However, with a damaged gut wall they are likely to absorb most of their foods partially digested, which may cause an immediate reaction or a delayed reaction (a day, a few days or even a couple of weeks later). As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day. Testing for food allergies is notoriously unreliable: if one had enough resources to test twice a day for two weeks, they would find that they are “allergic” to everything they eat. As long as the gut wall is damaged and stays damaged, you can be juggling your diet forever removing different foods and never get anywhere.”

Stool testing for pathogens.  There are times when I will use stool testing for pathogens.  And when someone has a positive finding for certain pathogens, such as yeast, parasites, or other pathogens, there is an excellent chance that this is a true finding.  However, false results aren’t uncommon.  In other words, someone might test negative for yeast, even though they have a Candida infection.  As I mentioned in my article on Candida entitled “Candida and Thyroid Autoimmunity“, stool testing isn’t the best method of detecting a Candida infection.  One can also have parasites and test negative for these on a stool panel.  This seems to be true even with the newer technology some of the labs are using.  So does this mean such testing shouldn’t be utilized?  Well, I think there is value in doing such testing at times, but these are also expensive tests, costing hundreds of dollars.  And so it’s not one I would routinely run on all of my patients.  On the other hand, I know some natural healthcare professionals who do recommend stool panels to all of their patients.

Micronutrient testing.  I mentioned some of the flaws with the hair mineral analysis test, but what about micronutrient testing?  This type of testing looks for intracellular deficiencies.  In other words, it measures how certain nutrients are functioning within the white blood cells.  This type of testing evaluates all of the vitamins, minerals, amino acids, and numerous antioxidants.  I was very excited when I found out about this method of testing.  The problem is that the research is still lacking.  If there was a test which could accurately detect all of the nutrient deficiencies of my patients I would recommend this type of testing to everyone.  And although I find micronutrient testing to be interesting, I once again have a hard time recommending such expensive testing to everyone if I’m not certain that the results are accurate.  Keep in mind that I’m not saying that this type of testing isn’t accurate, but simply that there is no research I’m aware of which proves that this type of testing is accurate.

Organic acids testing. The company Metametrix is one of the companies which offers testing for organic acids, and gives the following definition of such testing: “Organic acids are metabolic intermediates produced in pathways of central energy production, detoxification, neurotransmitter breakdown, and intestinal microbial activity. Accumulation of specific organic acids in urine often signals a metabolic inhibition or block. This abnormality may be due to a nutrient deficiency, an inherited enzyme deficit, toxic build-up, or drug effect. Testing for organic acids helps reveal activity and changes at the metabolic level, helping practitioners discover hidden issues and pinpoint where therapeutic focus is needed.”  There are other labs which offer this type of testing, such as Great Plain Laboratories.

The organic acids test does have some value.  However, it is another expensive test, and false results are possible as well.  Plus, there is also controversy over the different types of methodologies used, which is GC/MS (Gas Chromatography/Mass Spectrometry) or LC/MS/MS (Liquid Chromatography/Tandem Mass Spectrometry). LC/MS/MS is the newer type of technology, but this doesn’t necessarily mean it’s the more accurate one.  One of the labs which utilizes the GC/MS technology wrote a paper why this technology is superior to the LC/MS/MS.  The paper is convincing, but of course has a biased view.

Applied kinesiology.  This isn’t the same as the other types of testing listed here.  As described by the website www.appliedkinesiology.com, “Applied kinesiology (AK) is a form of diagnosis using muscle testing as a primary feedback mechanism to examine how a person’s body is functioning.”  The reason I brought this up is because I know of numerous healthcare professionals who won’t do any of the testing I mentioned above, but will only utilize applied kinesiology on their patients.  In fact, some won’t even recommend blood testing, and so if someone has a suspected thyroid or autoimmune thyroid condition, they will just do applied kinesiology on the patient, and nothing else.  And the reason why they don’t do any additional testing is because it won’t change their recommendations.  This doesn’t describe everyone who uses applied kinesiology, as I know healthcare professionals who use this, but also require blood testing on all of their patients.

I have a good friend who practices applied kinesiology in his practice.  And I’ve worked with numerous patients who have seen one of these practitioners and received very good results with them.  The problem is that this type of “testing” solely relies on the skill of the practitioner.  While this might be fine for someone who is competent and has been using this technique for many years, in my opinion it probably shouldn’t be relied on with someone who doesn’t have as much experience.  Once again, I didn’t list this technique here because I disapprove of it.  After all, let’s not forget I also listed the saliva testing and hair mineral analysis as having limitations, even though I recommend these tests to my patients.  I decided to mention this in this post because even though those doctors who utilize this technique have the utmost confidence that it will provide them with the information they need to restore the person’s health back to normal, it still has limitations as well.

There are other tests I haven’t listed here which have limitations, but these are some of the most well known ones.  And this doesn’t mean that these tests don’t have value.  Obviously I wouldn’t continue recommending the saliva testing and hair mineral analysis to my patients if I didn’t think they provided information which helped to restore their health back to normal.  Similarly, other healthcare professionals utilize other types of testing which have limitations, but provide them with valuable information.  My goal wasn’t to try to criticize any specific testing method or technique, but was just to make you aware of some of the limitations and controversies involved.

When it comes to avoiding specific foods, I truly believe that if you do enough research you can find a reason to not eat anything.  If you follow a strict Paleo diet then you will be avoiding dairy and grains.  If you’re a vegan then you of course don’t eat meat, fish, dairy, or eggs.  In addition to this, if you have gut problems and are trying to avoid lectins, phytic acid, and other antinutrients, then besides avoiding grains you will want to cut out nuts, seeds, and legumes.  Let’s not forget sugar, and so we might as well cut out the fruit.  And it probably would be a good idea to stop eating nightshade vegetables since they can be inflammatory.  And if you’re hypothyroid then you might want to cut out the goitrogenic foods too.

The focus of this blog post is on spinach, which of course is a very healthy food.  While it might not give you a boost in strength like it does with Popeye, eating spinach is high in nutrients such as vitamin A, magnesium, folate, and vitamin K.  In fact, I frequently add spinach to my smoothies.  Sometimes I will also eat spinach in a salad, along with other greens.  And when I have the forbidden pizza, I enjoy adding spinach and garlic to it.  Even my vegetable-hating children “tolerate” spinach.

If spinach is so wonderful, why did I decide to write a blog post which questions whether people with thyroid conditions should avoid spinach?  Well, there are definitely worse foods you can eat other than spinach.  And as I mentioned before, if you do enough research you can make a case for avoiding just about any food.  But as much as I like spinach, there are risks of eating it with both hypothyroid and hyperthyroid conditions.

Spinach and Hypothyroidism. Spinach supposedly has goitrogenic properties.  However, it’s not as goitrogenic as other foods, such as the cruciferous vegetables.  For more information on goitrogens I would check out my articles entitled “Goitrogens: Thyroid Inhibiting Foods You Should Avoid” and “An Update on Goitrogenic Foods and Their Impact On Thyroid Health“.  If you read these articles you’ll realize that a number of years ago I was opposed to people with hypothyroid conditions eating any goitrogens, but based on the lack of human research studies involving goitrogenic foods I have eased up a bit on this.  Although I’m still cautious about people with hypothyroid conditions eating a lot of goitrogenic foods, in most people, eating a normal amount of these foods shouldn’t cause any problems.

So let’s ask the question “should people with hypothyroid conditions avoid eating spinach?”  As I just mentioned, if someone has a hypothyroid condition then I think it’s fine for them to have one or two servings per day of goitrogenic foods.  However, this also assumes they don’t have an iodine deficiency, as goitrogens interfere with iodine metabolism.  Assuming someone with hypothyroidism or Hashimoto’s Thyroiditis is iodine sufficient then I think it’s fine for them to eat spinach, along with other goitrogenic foods such as broccoli, kale, and cauliflower.

Spinach and Hyperthyroidism. Since spinach is goitrogenic and can therefore inhibit thyroid hormone production if eaten in large quantities, then it might make sense for people with hyperthyroidism and Graves’ Disease to load up on spinach!  From a goitrogenic standpoint I’m not at all concerned about people with hyperthyroidism eating spinach.  So why would there be any problem with people who have hyperthyroid conditions eating this green leafy vegetable?

Well, one of the main concerns with hyperthyroidism is that over a period of time it can lead to a decrease in bone density.  This yet another reason why unmanaged hyperthyroidism can cause problems.  In my articles and blog posts I tend to focus a great deal on the cardiac symptoms, but a decrease in bone density can also be a big concern.  This is even true after the thyroid hormone levels are back within the normal range.  So for example, if someone has elevated thyroid hormone levels for six months which causes a decrease in bone density, then just normalizing the thyroid hormone levels won’t necessarily correct the bone density problem.  So someone can still be more susceptible to suffering from a fracture.

At this point you might be thinking to yourself “what does this have to do with spinach consumption?”  Well, one of the nutrients which is important for strong bones is calcium.  And while other nutrients are also important for proper bone health, such as magnesium, phosphorus, and vitamin D, if someone has a calcium deficiency then this without question can affect bone density.  The good news is that spinach is high in calcium.  The bad news is that it also is high in something called oxalate, which binds to calcium, and therefore reduces its absorption.  As a result, eating a lot of spinach can actually cause a calcium deficiency, and therefore affect bone density.

Spinach Isn’t The Only High-Oxalate Food

Spinach isn’t the only food which has high amounts of oxalates.  Many other foods are high in oxalates, including blueberries, blackberries, raspberries, beets, okra, almonds, cashews, and other whole foods are high in oxalates.  The topic of oxalates probably deserves a separate article or blog post, but just understand that most people are fine eating foods with oxalates.  Although some people have conditions which require a low oxalate diet (no more than 50 milligrams per day), this isn’t a concern for most people.

However, there are risks with eating high amounts of oxalates.  I mentioned how they can potentially affect the absorption of certain nutrients such as calcium.  However, there is also evidence that consuming high levels of oxalates can lead to kidney stones (1) (2).  Once again, this doesn’t mean that eating normal amounts of blueberries, raspberries, spinach, and other high oxalate foods will lead to kidney stones.  One problem is that we’re in a “smoothie era”, and many people load up their smoothies with these foods.  I’m guilty of this myself, as I love smoothies, and in the past I would add 1/2 cup of berries, along with a full cup of spinach on a frequent basis.  I still include the berries, and while I do add some raw spinach every now and then to my smoothies, I don’t do this on a daily basis, as I rotate the vegetables that I add to them.

So let’s ask the question “should people with hyperthyroid conditions avoid eating spinach?”  Well, one thing I should add is that although cooking does seem to reduce the goitrogenic activity of spinach and other goitrogenic foods, cooking doesn’t seem to reduce the oxalate content.  And so from this standpoint it really doesn’t matter if you eat raw or cooked spinach.  I think it’s fine for most people with hyperthyroid conditions to eat spinach, but it probably would be a good idea to not load up on this food.  There are so many different vegetables out there, and while some vegetables other than spinach have a high oxalate content, there are many vegetables with a low oxalate content such as cucumbers, arugula, asparagus, broccoli, cabbage, cauliflower, romaine lettuce, and squash.

In summary, spinach is considered by most people to be a healthy food.  The purpose behind this blog post wasn’t to discourage anyone from eating spinach.  I still eat spinach, and think it’s fine for most people to continue to do so, regardless of whether they have a hypothyroid or hyperthyroid condition.  The main reason I decided to write this post is to demonstrate that there can be risks with eating large amounts of healthy foods.  This doesn’t necessarily mean that eating high amounts of spinach on a frequent basis will inhibit thyroid activity or eventually lead to osteoporosis or kidney stones, but in some people eating a lot of spinach will cause problems.   This is one reason why it’s best to try to eat a wide variety of foods whenever possible, and try your best to avoid eating large amounts of a single food on an everyday basis.

Most people with overt hypothyroid conditions have high TSH levels, and low or depressed thyroid hormone levels.  Then there are people with subclinical hypothyroidism, characterized by an elevated TSH and normal thyroid hormone levels.  Many people with Hashimoto’s Thyroiditis are considered to have subclinical hypothyroidism, as while the damage the immune system is causing to the thyroid gland usually results in high TSH levels, it usually takes many years before the thyroid hormone levels become depressed.  However, a small percentage of people have the condition known as thyroid resistance.

Thyroid hormone resistance is characterized by elevated thyroid hormone levels (free T3 and/or free T4), and normal or elevated levels of TSH (1).  It’s not uncommon for people with this condition to have a goiter, but the hypothyroid symptoms usually are very mild, and sometimes the person doesn’t experience any hypothyroid symptoms at all.  In the past I’ve spoken numerous times about insulin resistance, where the cells don’t respond to the actions of this hormone.  In other words, the body produces normal amounts of insulin, but the body becomes resistant to the effects of this hormone and is unable to utilize it efficiently.  It’s a similar situation with thyroid resistance, as there might be sufficient levels of free T3 and free T4, but the cells don’t respond to the actions of thyroid hormone.

What Causes Thyroid Resistance?

Although genetics can play a role in insulin resistance, this condition is commonly caused by lifestyle factors, such as eating too many refined foods and sugars.  With thyroid hormone resistance, there can be numerous causes.  Some of the potential causes include genetic mutations, drugs, chemicals, metabolites, and autoimmune antibodies that may impair thyroid hormone action in the cell (2).  In addition, certain conditions such as chronic fatigue syndrome and chronic renal failure can be accompanied by acquired thyroid hormone resistance caused by inhibition of thyroid hormone metabolism, cell uptake, and thyroid hormone receptor binding and transcription (2).  As I’ll discuss later in this post, certain nutrient deficiencies can also play a role in thyroid hormone resistance.

Sometimes it can be challenging enough to find out if someone has thyroid hormone resistance, but even if this has been determined, how can one find out the cause of this condition?  This also can be a challenge, as I’m not aware of any specific testing which is available to patients or healthcare professionals which will determine if someone has a genetic mutation which is causing this.  Certain environmental toxins such as PCBs and dioxins might cause thyroid resistance, although such chemicals might play a greater role in congenital hypothyroidism (3). Other toxins might also inhibit the binding of thyroid hormone to the receptor (4).  While it is possible to test for some of these environmental toxins, doing so can be quite expensive, and so it’s probably more cost effective to just do things to detoxify your body.  Other substances that might affect the thyroid receptors including iodocontrast agents (5), amiarodone (6), and phloretin (7).  A few different drugs can also bind to specific thyroid receptors (8), and so if someone started taking a certain medication and soon thereafter developed a thyroid condition, one has to consider the possibility that taking this drug was responsible for this.

Can Natural Treatment Methods Help With Thyroid Resistance?

If someone has a genetic polymorphism which is causing thyroid hormone resistance then there isn’t a way to reverse this problem.  However, this is rare, and many cases of thyroid resistance can be helped through natural methods.  As I mentioned earlier, certain environmental chemicals can bind to the thyroid receptors and cause thyroid resistance, and so doing things to detoxify your body would be a good place for many people to start.  I discussed this in a blog post I previously wrote entitled “3 Ways People with Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.  Detoxification can also help someone who developed thyroid resistance due to a certain medication they’re taking, although if someone suspects that a prescription drug is responsible for their thyroid condition then it would be a good idea to run this by their medical doctor so they can take the person off of the drug, or perhaps switch them to a different drug which hopefully won’t have the same side effect.

Certain nutrients can affect the thyroid receptors and can alter the effect of T3 at the gene transcription level (9).  Since the binding of T3 to the receptor is retinoic acid-dependent (10), taking vitamin A might benefit people with thyroid hormone resistance.  Of course you want to be careful about taking high doses of vitamin A, as this can be toxic.  The T3 receptor is thought to require zinc to adopt its biologically active conformation (11), and so a zinc deficiency can play a role in thyroid resistance. There is also evidence that taking fish oils can support the thyroid receptors as well (12).

This isn’t to suggest that everyone with thyroid hormone resistance should “load up” on vitamin A, zinc, and fish oils.  The first thing one should do is make sure they’re eating a diet consisting of whole foods, while minimizing the refined foods and sugars.  If someone is deficient in these and other nutrients it’s usually due to a poor diet, although it can also be due to absorption problems.  If this is the case then the absorption issue needs to be addressed in order to obtain maximum benefits from the food you eat, and any supplements you might take.

In summary, thyroid resistance is a condition characterized by elevated thyroid hormone levels, and normal or elevated TSH levels. Numerous factors can cause thyroid resistance, such as mutations, drugs, environmental toxins, and nutrient deficiencies.  Many cases of thyroid resistance can be helped naturally.  Since toxins are a common cause of this condition, doing things to detoxify your body and increase glutathione levels would be a good idea for most people.  If a medication is responsible for this condition then of course this needs to be addressed.  Certain nutrients affect the thyroid receptors, such as vitamin A, zinc, and fatty acids, and so making sure you’re getting these nutrients in your diet is also very important.

Most people with thyroid and autoimmune thyroid conditions don’t have a good understanding when it comes to the different types of serum tests used to evaluate thyroid health. Although it is true that blood tests don’t tell the entire story, I do think it’s important for people who choose to follow a natural treatment protocol to at least have a basic knowledge of the different types of blood tests. As a result, I’ve decided to put together a post which discusses the most important “thyroid” blood tests.

Thyroid stimulating hormone (TSH). Although many medical doctors primarily pay attention to the TSH, it’s important to understand that the TSH is actually a pituitary hormone. The role of the TSH is to stimulate the thyroid gland to produce the thyroid hormones (T3 and T4). It is synthesized and released by the anterior pituitary gland. So when someone has a hypothyroid condition, which is characterized by low or depressed thyroid hormone levels, the pituitary gland will secrete more TSH. This explains why the TSH is high in hypothyroid conditions. Due to the decrease in thyroid hormone, greater amounts of TSH will be released. On the other hand, if someone has a hyperthyroid condition, this of course is characterized by an excess of thyroid hormone. As a result, the pituitary gland will stop secreting TSH because it doesn’t want to stimulate the thyroid gland to produce more thyroid hormone. Because of this the TSH will be depressed.

Why do most medical doctors focus on the TSH when someone with hypothyroidism or Hashimoto’s Thyroiditis is taking synthetic thyroid hormone (i.e. levothyroxine)? The reason is because taking synthetic thyroid hormone will usually help to lower the TSH, but it won’t have an effect on the actual thyroid hormone levels. So when someone has Hashimoto’s Thyroiditis and is given synthetic thyroid hormone, most medical doctors will ignore the autoimmune response, as their primarily goal is to get the TSH within the normal reference range.

There of course are a few problems with this. The first problem is that taking thyroid hormone isn’t doing anything to address the autoimmune response. Another issue is that the upper end of the lab reference ranges tend to be too high with regards to TSH. For example, a common lab reference range is between .8 and 4.5 mlU/L. However, the functional reference range is between 1.0 and 3.0, and some claim that it should be between 1.0 and 2.0. But even if you get someone’s TSH between the functional reference range, many people still don’t feel well because the underlying cause of their condition hasn’t been addressed.

Free T3 and Total T3. Triiodothyronine, also known as T3, is a type of thyroid hormone. This is the active form of thyroid hormone which is important in regulating the body’s metabolism. The free T3 represents the free form of triiodothyronine in the blood. On the other hand the total T3 represents both the free and bound form of triiodothyronine. Over 90% of T3 is bound to proteins, and while I do think there is value in testing the total T3, because the free T3 is the active form of the hormone then it makes sense to test this as well. Although some T3 is produced directly from the thyroid gland, most of the T3 is produced through the conversion of T4. In hyperthyroid conditions the free T3 and total T3 are usually high, while in hypothyroid conditions the free T3 and total T3 are usually on the low side.

Which of these two values should be tested? Well, ideally it would be great for both of them to be tested. However, if someone has to choose between the two then it really depends on what one is looking for. As an example, if someone wants to monitor the thyroid hormone levels to see if someone has high or low thyroid hormone levels, it is usually preferable to test for the Free T3 since it is the unbound form of the hormone and thus is what produces a biological response. For example, if someone has hyperthyroidism, ultimately it’s the high levels of Free T3 which lead to the hyperthyroid symptoms. On the other hand, if someone wants to determine whether T4 is being properly converted into T3, then either the total T3 or the free T3 will be fine to measure. Or they might want to look at the reverse T3, which I will discuss shortly.

T3 Uptake. Thyroid-binding globulin (TBG) is what binds thyroid hormone, and helps to carry both T3 and T4 in the bloodstream. The T3 uptake test tells us how much TBG is bound by T4. For example, when TBG concentration is decreased, less TBG is available to bind labeled triiodothyronine (T3), and more labeled T3 reagent binds to the solid-phase material (increased T3 uptake) (1). T3 uptake is typically increased with hyperthyroid conditions, and decreased with hypothyroid conditions. Keep in mind that other factors can cause an increase in T3 uptake (i.e. anabolic steroids such as testosterone), while some other factors can cause a decrease in T3 uptake, such as xenoestrogens.

Free T4 and Total T4. Thyroxine, also known as T4, is a type of thyroid hormone. Just as is the case with T3, the free T4 represents the free form of thyroxine in the blood, whereas the total T4 represents both the free and bound form of thyroxine. As I mentioned before, T4 is converted into T3. In hyperthyroid conditions the free T4 and total T4 are elevated, while in hypothyroid conditions the free T4 and total T4 are on the low side.

It’s also important to understand that synthetic thyroid hormone consists of T4. Even though it is synthetic, the body can still convert it to triiodothyronine (T3). However, some people have problems with the conversion process and are given synthetic T3 (i.e. Cytomel). Natural thyroid hormone consists of both T4 and T3, as well as T1 and T2, which I won’t be discussing in this blog post.

Which of these two values should be tested? Free T4 or total T4? As I mentioned with triiodothyronine, it would be wonderful if both the total T4 and free T4 can be tested. But if choosing only one of these tests then one wants to look at the free form of the hormone. Fortunately most endocrinologists realize this and will test for free T4. However, there are some who will only test for total T4 and not free T4.

Thyroid-Binding Globulin (TBG). I briefly mentioned this test earlier, as this is a protein that moves the thyroid hormones throughout your body. One will typically see increased TBG levels in hypothyroidism, and decreased TBG levels in hyperthyroidism. However, other factors can cause this to increase or decrease. For example, certain drugs can increase TBG levels such as oral contraceptives. Liver disease can also increase these levels, and TBG levels are normally increased during pregnancy. On the other hand, certain drugs such as prednisone, dilantin, and high doses of salicylates can decrease TBG levels.

Free Thyroxine Index (FTI). The free thyroxine index was used more commonly before the free T3 and free T4 tests were made available. It is obtained by multiplying the total T4 with the T3 uptake, and might be useful to measure thyroid function when there are abnormalities in plasma protein binding. The free thyroxine index is typically high in hyperthyroidism, and usually low in hypothyroidism.

Reverse T3 (RT3). As I mentioned earlier, T4 is converted to T3. However, some T4 is also converted to reverse T3. I won’t get into much detail about reverse T3 here, as for more information you can read a separate article I wrote entitled “Reverse T3: What You Need To Know About It“. What I will say here is that some reverse T3 is normal, but you don’t want to have too much, as this usually indicates a conversion problem between T4 and T3. And as I mentioned in the article, chronic stress frequently leads to high RT3 levels. The reason for this is because elevated cortisol levels can inhibit the conversion of T4 to T3. Since the liver is also responsible for the conversion of T4 to T3, having a liver that isn’t functioning optimally can also lead to higher levels of RT3.

Thyroid peroxidase (TPO) antibodies. Thyroid peroxidase, also known as thyroperoxidase, is an enzyme produced by the thyroid gland which helps with the production of thyroid hormone. In fact, when someone takes antithyroid medication (i.e. methimazole or PTU), this essentially is inhibiting this enzyme. Thyroid peroxidase antibodies inhibit thyroid peroxidase, and so the thyroid gland is unable to produce sufficient amounts of thyroid hormone. This typically results in elevated TSH levels. And while taking synthetic or natural thyroid hormone can help to lower the TSH, it won’t do anything to address the autoimmune response, and thus lower these antibodies. TPO antibodies are frequently high in Hashimoto’s Thyroiditis, although it’s not uncommon for those with Graves’ Disease to have elevated levels of these antibodies as well.

Thyroglobulin antibodies. Thyroglobulin (Tg) is a glycoprotein homodimer produced predominantly by the thyroid gland (2). It acts as a substrate for the synthesis of thyroxine and triiodothyronine as well as the storage of the inactive forms of thyroid hormone and iodine (2). In other words, thyroglobulin is a protein produced by the thyroid gland, and it is important for the synthesis of T3 and T4. Thyroglobulin antibodies attack and damage this protein, which leads to the decreased production of thyroid hormone. Elevated thyroglobulin antibodies are common in people with Hashimoto’s Thyroiditis, although some people with Graves’ Disease can have these antibodies as well.

TSH receptor antibodies (TRAbs). There are two types of TSH receptor antibodies. Thyroid stimulating antibodies (TSAb), also known as thyroid stimulating immunoglobulins (TSI), are the main antibodies associated with Graves’ Disease. They stimulate or bind to the TSH receptors, which in turn cause the thyroid gland to produce excessive amounts of thyroid hormone. These antibodies can also attack the tissues of the eye, and can therefore cause thyroid eye disease, also known as Graves’ opthalmopathy. There are also TSH-stimulation blocking antibodies( TSBAb), which causes hypothyroidism. TSBAb-positive patients with hypothyroidism and Graves’ patients with hyperthyroidism may have both TSBAb and TSAb (3).

One important thing to keep in mind is that the absence of thyroid antibodies doesn’t necessarily rule out autoimmune thyroid disease. While testing positive for these antibodies will confirm the presence of an autoimmune thyroid condition, these antibodies can fluctuate, which is why you never want to rely on a single reading. As a result, if an autoimmune thyroid condition is suspected, yet the person tests negative for thyroid autoantibodies, it would be a good idea to test these again in a few months.

So hopefully you have a better understanding of the different types of thyroid blood tests available. While some medical doctors only test for the TSH and thyroid hormone levels, the other tests do have some value. However, also keep in mind that while these tests can provide valuable information, one can’t rely on blood tests alone. For example, just because someone has their TSH and thyroid hormone levels within the normal reference range doesn’t mean they don’t have a problem with the thyroid gland. Remember that the thyroid antibodies will develop before the TSH and thyroid hormone levels become out of range. In fact, with a condition such as Hashimoto’s Thyroiditis, the thyroid antibodies might be elevated for many years before they cause significant damage to raise the TSH and eventually decrease the thyroid hormone levels.

In last week’s blog post I discussed some of the most common causes of gut problems.  This included a poor diet, antibiotic use, chronic stress, pathogens, and toxins.  I also discussed how having a compromised gut can lead to an autoimmune condition such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, for many people with an autoimmune thyroid condition, restoring the health of their gut can in turn restore their thyroid health.  In this post I’m going to discuss some of the things you can do to have a healthy gut.

Strategy #1: It all starts with eating well. One of the most common reasons why so many people have gastrointestinal problems is due to eating poorly.  Obviously you need to eat a diet consisting of whole foods, while avoiding the refined foods and sugars.  Common allergens such as gluten and dairy should also be avoided while trying to restore your health.  Having an intolerance to other foods is also possible, and many times it can be a challenge to find out which foods people are sensitive to.  Although food intolerance testing is available, these panels are expensive and aren’t complete accurate.  Many times an elimination diet is the best option, although it of course takes time going this route, and one can’t always rely on symptoms to determine if there are food intolerances.  In addition to avoiding common food allergens and being cautious about other food sensitivities, some people need to avoid other foods.  For example, if someone has small intestinal bacterial overgrowth or a different condition then they might need to be on a low FODMAPS diet. Some people have problems with oxalates and/or salicylates and therefore need to eat foods which are low in these.

Some people can benefit from following a protocol similar to the GAPS diet, which can be an effective diet, although it is very strict.  I usually have my patients follow a Paleo type diet.  If someone has a lot of food intolerances then this is when I will commonly recommend the GAPS diet.

While I’m sure many people reading this information have already made some wonderful changes to their eating habits, one thing to keep in mind is that if someone has been eating poorly for many years, then sometimes changing their diet alone won’t be sufficient to restore their gut health back to normal.  For example, growing up my diet was horrible, as I ate refined foods and sugars on a daily basis, drank plenty of cow’s milk, soda, and fruit punch, and frequently ate fast food.  I did this for about two decades of my life, and while I don’t recall having a lot of bloating or gas, I did have chronic constipation.  And when I eventually changed my eating habits it took many months to experience positive changes in my bowel movements.  But they still were far from normal, and it wasn’t until years later (after I was diagnosed with Graves’ Disease) when I began making further changes to my daily eating habits that I was able to have daily bowel movements.

Strategy #2: Do everything you can to avoid taking antibiotics and NSAIDS. Although there are other prescription drugs which can have a negative impact on your gut heath, probably the two worse drugs to take with regards to gut health are antibiotics and NSAIDS.  I realize that sometimes taking antibiotics are necessary, but many people take antibiotics when they don’t truly need to.  If someone absolutely needs to take antibiotics then they want to take a good quality probiotic supplement during this time.  It also is a good idea to eat plenty of fermented foods.  Then once they are done taking the antibiotic they will want to continue taking the probiotic supplement at least for a few months, and of course continue to eat fermented foods.  For more information on probiotics I recommend reading my article entitled “Can Taking Probiotics Improve Thyroid Health?“.

And of course NSAIDS should be avoided whenever possible.  Once again, I realize that there might be times when someone needs to take this medication.  But they should be taken on a short term basis due to the severe side effects associated with this prescription drug.  If at all possible someone should try to substitute antibiotics and NSAIDS with natural antimicrobials and natural anti-inflammatory foods and supplements.  I’ll talk more about natural antimicrobials shortly when I discuss pathogens.  As for natural anti-inflammatory foods and supplements, eating plenty of fresh vegetables, drinking green tea, and consuming omega-3 fatty acids, turmeric, ginger, and resveratrol can help greatly with the inflammation.  Vitamin D can also play a very important role in inflammation, and many people are deficient in vitamin D.

Strategy #3: Become an expert in managing stress. In last week’s blog post I discussed how chronic stress can affect the gastrointestinal tract.  I talked about how stress can cause problems with gastrointestinal motility, have a negative effect on the regenerative capacity of the GI mucosa, and can lead to a leaky gut.  So even if you are eating an almost perfect diet, if you are stressed out all of the time then this can affect the health of the gut.

In this day and age it’s a challenge to effectively manage stress.  But doing so is necessary for anyone who is looking to restore their health by following a natural treatment protocol.  Part of the problem is that many people don’t block out any time for stress handling.  It’s a catch-22 situation, as many people are so busy with their job and/or taking care of their family that it’s a challenge to find the time to work on improving their stress handling skills.  But doing so is necessary in order to achieve optimal health.

I’m in such a situation, as between consulting with patients, responding to emails, writing articles and blog posts, and trying to spend time with my family I don’t have much time to work on my stress handling skills.  But I block out at least 10 to 15 minutes each day to do this, and most people can do this too.  Even if you start out with five minutes per day this is better than nothing.  And then once you’re in the routine of managing your stress on a daily basis you can gradually increase the amount of time dedicated to this.

As for what you can specifically do to manage your stress, I’ll refer you to an article I previously wrote entitled “7 Stress Management Tips To Help Restore Your Thyroid Health“.  Although three of the tips involve 1) being aware of the impact stress has on your health, 2) eating a healthy diet, and 3) exercising regularly, in addition to doing these, just about everyone should incorporate at least one additional stress management technique into their daily routine.  I personally do biofeedback, but others might do some deep breathing and meditation on their own, while other people might prefer to do yoga, tai chi, or something else on a daily basis to manage their stress.  But it is important to do this every day, even if it is only 10 to 15 minutes per day.  Obviously it would be better to block out 15 to 30 minutes a couple of times per day, but even spending 10 minutes per day on stress management will be beneficial.

Strategy #4: Cautiously eradicate pathogens. Since pathogens can potentially trigger an autoimmune response, then it would make sense to eradicate any pathogens which are present, right?  Well, if someone with an autoimmune thyroid condition has a pathogen such as H. Pylori present then I agree it needs to be eradicated.  However, there are a few things you need to keep in mind.  First of all, antibiotics are frequently used to eradicate pathogens.  And as I mentioned earlier, one should try to avoid taking antibiotics whenever possible.  In most cases antibiotics should be reserved for acute infections (although not everyone who has an acute infection needs to take an antibiotic).

However, if someone has a chronic gastrointestinal infection, while antibiotics might help, they will also disrupt the gut flora.  And so whenever possible I will first try to use natural antimicrobials such as garlic, turmeric, oregano oil, and/or berberine.  Be aware that some natural antimicrobials can cause problems with the good bacteria of the gut.  For example, taking high doses of citrus seed extract can affect both good bacteria and bad bacteria.  I mentioned garlic and turmeric before, which are relatively safe.  But I also mentioned oregano oil and berberine, and while I commonly use these as antimicrobials, taking high doses of these for a prolonged period of time might have a negative effect on the gut flora.  In addition, certain herbs can be toxic if taken for too long, including wormwood, which is commonly recommended by natural healthcare professionals (including myself) to help with parasites.

While taking natural antimicrobials can be beneficial, probably the most important thing you can do is to improve the overall health of your immune system.  And while one can take immune modulating supplements and herbs on a short term basis to help with this, the best way to improve the health of your immune system is by following all of the other advice I have given in this post.  In other words, eating well, managing your stress, and minimizing your exposure to toxins will do wonders in keeping your immune system healthy and strong.  Getting sufficient sleep is also very important.

Strategy #5.  Detoxify your body on a frequent basis. There are so many different toxins we’re exposed to on a daily  basis, and while you can do things to help minimize your exposure to toxins, you also need to do things to help detoxify toxins from your body.  Eating mostly organic food, using natural household products, and doing other things to minimize your exposure to toxins can help.  Just keep in mind that organic food isn’t completely toxin free, and of course many homes are toxic as well.  And even if you take measures to minimize the toxins in your home, simply stepping outside of your house and breathing the “fresh” air will expose you to numerous toxins.  As a result, you always need to work on eliminating toxins from your body.

I have written a separate blog post entitled “3 Ways People With Thyroid and Autoimmune Thyroid Conditions Can Detoxify Their Body“.  In this post I spoke about how you can detoxify your liver through eating certain foods such as cruciferous vegetables, garlic, and cilantro.  You can also take certain supplements and herbs if necessary such as chlorella, milk thistle, and N-acetylcysteine.  I also discussed colon cleansing and sauna therapy.

However, if someone has a condition such as leaky gut syndrome then they want to be cautious when detoxifying their body.  While doing things to increase glutathione levels and eliminate toxins is usually fine, I would refrain from using more aggressive detoxification methods such as colon hydrotherapy.  Keep in mind that I’m not opposed to colonics, as they can be a very effective method of eliminating toxins.  But if someone has an increase in intestinal permeability then this should be addressed first.

Strategy #6.  Implement gut repair strategies (if necessary). If someone has a condition such as leaky gut syndrome then eating well can help, but it also might be necessary do certain things to assist with the gut repair.  L-glutamine is one of the most commonly used nutrients to help repair the gut, as it serves as fuel for the enterocytes.  Certain probiotics can also help with gut repair, such as Saccharomyces Boulardii.  You can also heal the gut by eating certain foods such as bone broth.

Strategy #7: Don’t forget about the gallbladder. The gallbladder plays a big role in digestive health, as it stores bile, which is important with regards to the digestion of fats.  Even though bile is stored in the gallbladder, it is actually produced by the liver.  Some classic gallbladder symptoms include pain between the shoulder blades, although the person might also experience some discomfort on the upper right side of the belly.  Sometimes the pain can become quite severe.  Frequently there are digestive problems upon eating greasy foods, and sometimes even healthy fats.  Hundreds of thousands of people have their gallbladder removed each year, and most of these could have been prevented if the person were to clean up their diet and receive support for the liver and gallbladder.

In summary, having gut problems can lead to many chronic health conditions, including autoimmune thyroid disorders such as Graves’ Disease and Hashimoto’s Thyroiditis.  As a result, you want to do what is necessary to restore the health of the gut, such as eat well, manage your stress, try to avoid taking antibiotics and NSAIDS, be cautious when eradicating pathogens, detoxify your body on a frequent basis, implement gut repair strategies when necessary, and to optimize the health of your gallbladder.  All of these factors can be important when it comes to restoring the health of your gut.  Of course there are other factors I didn’t discuss in this post which can have an impact on gut health, and I will cover many of these factors in future articles and blog posts.