5 Tips to Reclaim Your Thyroid Mojo

Today I'm reminding you of and then manhandling 5 mojo-zappers. Five things that I often find are depleting the energy of vast numbers of patients in my integrative medicine practice. Five things I want on your radar. Five things I want you to remove from your less-than-metabolized life. Immediately.

1.     Dial in your free T3. I find this tracks with mojo more than any other indicator of your thyroid function. I like to see my patients in the top half of the normal range.

2.     Correct your low Vitamin D. Even with all the press this cute little hormone gets, 90% of my patients are low. Yet Vitamin D has over 1000 jobs in your cells. My fave? It drives thyroid hormone into your cell nucleus, where it can work its wonders. Get some. Keep your level above 52. For optimal metabolism, I like 70-90.

3.     Beware: Endocrine disruptors. These buggers are killing you softly. They’re in your jeans (2/3 of jeans are manufactured in China). They’re in your mattress. They’re in your canned food. They’re in your car upholstery. Reduce your exposure starting today. Get your organic mattress (although you may need a doctor’s prescription – how ridiculous is that?). Get organic jeans against your skin (they are far foxier than they used to be). Eat fresh, organic, seasonal food rather than the canned crap. Be mindful about your plastics and cleaning products.

4.     Check your cortisol. Adrenal dysregulation – that is, a cortisol that is either higher or lower than normal – can influence your thyroid functioning. Both high and low cortisol affects how much T3 you make.

5.     Meditate. It elongates your telomeres, the sweet little shoelace caps on your chromosomes, longer and slows down biological aging. Even beginners get a boost in telomere length, says Nobel prizewinner Elizabeth Blackburn!

Now tell us in the comments what else gets your thyroid mojo revved up. And lengthen those telomeres!

 xoxox Dr. Sara

Transdermal Thyroid Treatment? Huh?

I love to write about the Wiley Protocol because it is so wildly controversial. Perhaps best known for mimicking the estrogen and progesterone levels of a 20-something, with peak estradiol on day 12, and peak progesterone on day 21 given in a rhythmic fashion, did you know that you can get the Wiley Protocol for your thyroid?

T. S. or Susie Wiley is the creatrix of the Wiley Protocol. She is a medical theorist with a background in molecular biology. That'll become more relevant in a moment. But know that she is not a medical doctor.

Susie has been an avant garde thought leader in the realm of hormones for years. Her main contribution? That of RHYTHM – meaning that specific patterns of hormone levels are needed for harmony between sex hormones (estrogen, progesterone, testosterone), thyroid and adrenal hormones. There is a rhythm to our light/dark cycle, our food supply, families, plants, hypothalamus, pituitary, ovaries, thyroid and adrenals -- why not, as Wiley fan and oncologist Julie Taguchi, MD suggests -- mimic the buzzing and humming of our glands which send signals to grow, bloom, seed, hibernate or die? She has applied the concept of rhythm to the dose and timing of externally-applied transdermal hormones.

Say more.

Susie believes that we have to really understand each hormone in a woman’s body and how it acts both alone and as part of the symphony, rather than simply whether you are getting too much or too little Synthroid.

It makes sense theoretically: we know that there’s a see-saw relationship between thyroid hormone and estrogen levels, so when estrogen is up, thyroid is down. So in the Wiley Protocol, the idea is that you adjust your thyroid dosage with where you are in your menstrual cycle (in Wiley Land, that concept applies equally to pre- and post-menopausal women, with and without a uterus). In other words, static dosing of thyroid medication (same dose daily) deranges both estrogen and progesterone receptors.

Let me describe it another way: when you are cycle day 1-5, your estrogen is really low. On the standard Wiley Protocol Thyroid, that means you take 6 lines  (0.6mL as measured on their handy syringes) of T4 (21.8 mcg/line) + T3 (7.4mcg/line). The reason? T3 provokes an estrogen receptor, so you will improve estrogen turnover and make more estrogen receptors on target tissues. You then adjust down to a nadir of 1 line on peak estradiol day 12, and spike back up to 6 lines day s 14-16. And so on.

What positive things can I say about the Wiley Protocol Thryoid? I like the transdermal approach. As you know, absorption of your thyroid pills through your gut… well, it sucks. That’s why you are told to wait 20-60 minutes to eat or drink anything after you take your morning pills. So it makes sense that a transdermal approach is more convenient, and perhaps absorbed better.

I also like the adjustment with the menstrual cycle, especially for my patients who are exquisitely sensitive to the steady up/down of their estrogen (estradiol). Many of my patients find that they bloat like crazy at ovulation and just before/during their menses. Sometimes more thyroid hormone is the fix (but you must see your doc on this one – I do not recommend reckless experimentation in the service of bloat prevention).

Final positive are these: apoptosis and receptor turnover.

What the heck is apoptosis, you might ask.

Apoptosis is “Programmed Cell Death.” Now, before your eyes glaze over, let me point out why this is cool, important and relevant. Apoptosis is good – it’s designed to keep you young and vibrant. It’s a way of getting rid of the debris in your body without damaging you – it gets rid of receptors you no longer need, for instance. It confers advantages and is completely different from necrosis, which is cell death as a result of traumatic injury or cancer. In your body today, 50-70 billions will die as a result of apoptosis.

Receptor turnover is another important aspect of your glandular goodness. As an example, when women are given PremPro (estrogen from PREgnant MARe urINe and synthetic progesterone, proven to cause heart disease and breast cancer in women aged 50-79), the same dose every day makes your progesterone receptors stagnate. According to Susie and the data she cites, this results in inadequate cell apoptosis and a higher chance of disease such as breast cancer. In other words, chronic, same-dose-daily leads to down-regulation of progesterone receptors, and tissue badness downstream.

If you take the WP Thyroid Transdermal Restoration for Women, you check your thyroid function tests on day 13 or 14 because that is when your endogenous thyroid levels are at their maximum.

Negative feedback? There’s the absolute lack of randomized clinical trials, the gold standard for deciding if something is safe or even just a good idea. Recall all the trouble we got into with prescribing estrogen (1950-1999: take it! 1999-2002: never take it! Dangerous & risky! 2002-now: take it if you really need it, however you best define that! Confusing)? That was because we based our recommendations for estrogen on biased data (observational studies or worse quality), and randomized, controlled trials have the least bias.

Truth be told, I tried WPT for a few months. Actually, I try almost everything before considering it for my patients. I didn’t notice much difference in my bloating or hypothyroid symptoms (the usual: fatigue, easy weight gain – such as looking at a muffin, constipation).

Problem is this: we’ve got limited options as we augment or completely replace the function of our thyroid. I welcome new kids on the block. I find that selecting the right thyroid treatment is a lot like shoe shopping – it can often take nearly forever to find the right fit. So keep the faith and know there’s choices available. Check it out if you must, but buyer beware: no (unbiased) data, no data, no data.

Thyroid Goddessness

When I was 38, I discovered that my thyroid was a laggard. After having trouble losing weight post-partum from my second baby, and had a vague feeling that Kaiser's version of what constituted a normal thyroid test was different from my version. I decided to test my T3, and low and behold, the sucker was low. Soon I started a small dose of Armour Thyroid, and all was good in the world again: my body responded to exercise by losing fat, I didn't have to be as fastidious about what I ate, and my energy was vastly improved.

 As with many issues in integrative medicine, there's a gigantic gap between what conventional medicine has to say about what is normal thyroid function and what integrative or functional medicine offers. Daily I discover that my patients have a low free and/or total T3, the active version of thyroid hormone that makes you leap out of bed in the morning.  Or I find that they have autoimmune thyroiditis, and even thought their Thyroid Stimulating Hormone (TSH) is normal, they are making antibodies to their thyroid and heading toward a crash.

Many symptoms characterize an underactive thyroid but the top two are: weight gain and fatigue. Here are some other common symptoms: constipation (which I define as less than two bowel movements per day), cold hands and feet, depression, hair loss, joint achiness, poor memory and executive functioning, and increased cholesterol. The list is long and I have a questionnaire for you on the blog right here. Take the quiz to see if you should test, and consider performing a thyroid panel home test via Canary Club for free T3, TSH, free T4 and thyroid peroxidase antibodies. I am also a big fan of following your reverse T3 but I don't know where you can order that as a home test.

When you have thyroid issues, your diet requires your rapt attention. Got goitrogens in the food you're eating? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as broccoli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.

For more info on thyroid, I highly recommend Mary Shomon's excellent books as well as Thyroid Power by Dr. Richard Shames, MD. I challenge you to have goddess-like thyroid function, which is, after all, your birthright.

Imma Be Queen of Leptin

Many of us are waking up to the rather unwelcome slow-down of our metabolism now that we've hit 35 or 45 or 55 years. What helps? Becoming a master of the forces that shape your metabolism and how they interact with your other hormonal systems. Leptin is a major driver, and a lesser-know hormonal cousin to insulin, so I thought I'd repost my guest blog from Dear Thyroid on the leptin scoop - how it controls metabolism, how it relates to your sluggish thyroid and the muffin around your middle.

Ever wonder why you still feel hypothyroid yet your TSH is normal? Or why the weight you gained while hypothyroid hasn’t fallen away? A key intermediary hormone that many of us are unacquainted with is leptin, a regulator of both body weight and your thyroid control. Let leptin become your new BFF by getting to know her intimately and learning how she rocks your thyroid and weight.

If you haven’t heard of leptin, that’s because it was discovered relatively recently in 1994. It’s similar to insulin in its job description. Leptin acts as an important control system that makes telephone calls to other organs about the state of your fat balance and whether to go or stay in low-metabolism survival mode. It’s made in your fat cells, and more fat cells = higher leptin levels. The high leptin normally tells your hypothalamus that you don’t need to eat as much, so metabolism slows (you make more TRH, and this raises TSH) and the TSH tells your thyroid to crank out more thyroid hormone. This is when your leptin is communicating clearly and functionally, and your hypothalamus is responding appropriately.

Optimal Leptin

Ideally, leptin should be between 4-6. If your leptin is 4-6, your hypothalamus is getting the correct phone calls from leptin. If your level is above 10, your leptin receptors are fatigued, and the phone calls are no longer getting to or from the hypothalamus. Result? Metabolism slows inappropriately because the hypothalamus is interpreting the messages inappropriately.

Problem with Chronic Dieting

Chronic dieting and/or major stress are a common cause leptin resistance. As a result, leptin no longer has a clear line of communication with your hypothalamus and thereby your metabolism. Leptin resistance makes the hypothalamus believe that you are in starvation mode, and you make more fat, and slow down thyroid hormone production. TSH goes down, you don’t convert as much T3 (active thyroid hormone) from T4 (inactive), reverse T3 goes up, appetite increases (crazy unfair, sorry about that), and often you become insulin resistant, and slow down lipolysis (fat breakdown). More fat accumulates, you’re hungrier and you age prematurely. Not good!

Over time, you get fatter, especially at the mid-section, and it becomes increasingly difficult to lose the weight and fat. In fact, it takes herculean efforts.

High Leptin Renders TSH Unreliable

As if herculean efforts weren’t enough, If your leptin is high, TSH less reliably reflects your tissue level of thyroid hormones. For example, in diabetics who are almost universally leptin-resistant, T4-to-T3 conversion is cut in half without a change in TSH. While you may not be diabetic, you may still experience a significant reduction in your conversion before your TSH picks it up. This is where, yet again, measuring your free T3 (fT3) and reverse T3 (rT3) can help elucidate the issues.

More Bad News: Leptin & Thyroid Cancer

When your leptin rises in the blood, it increases (upregulates) leptin receptors on thyroid cancer cells causing them to become more aggressive. Does it help transform normal thyroid cells into malignant cells? We don’t know. But we do know that overzealous leptin receptors were found in 80% of thyroid cancers in one series published in 2009. Leptin has been shown to stimulate growth of thyroid cancers and reduce cell death.

How About PCOS?

Short version: leptin problems cause PCOS, both in lean and obese women. The science is quite complex, and involves loss of the timing of certain hormonal rhythms of both growth hormone and luteinizing hormone. From your comments to the last post, I’d like to offer a future blog post on all things PCOS, so please comment your questions and concerns.

OK, OK… Tell Me What to Do

Measure your leptin level. If it’s above 10, use nutrition as a first strategy to reset your level. I find that 70-80% of my patients are successful just by making the nutritonal changes that are recommended for reversing leptin resistance, such as Dr. Ron Rosedale’s program (http://www.drrosedale.com) or Byron Richards 5-step plan. Dr. Rosedale presents a food program in his book that includes elimination of fruit except avocadoes and olives for three weeks and limited starchy foods. There is far more detail in his book. I find the food changes are the primary way to lower leptin; nutraceutical supplements are another approach that may augment your success with leptin-sensitizing foods.

Here again (similar to what we reviewed in my blog post last week), we want to normalize both the thyroid and the leptin levels simultaneously for the best results. What works in those who are not successful with the nutritional program to lower leptin is to add prescription therapies. I don’t like the prescription approach – I favor using natural therapies but they require deep commitment to change old eating patterns. HCG treatment has also been successful, but that’s a hugely controversial approach that merits it’s own blog post!

While leptin resistant, make sure your free T3 and reverse T3 are being managed properly. I like to see the free T3 mid-range for your lab, and the fT3/rT3 >1.8 (when fT3 is in units of ng/dl).

As leptin lowers, your TSH will more accurately reflect your tissue levels, assuming you are also limiting stress and exposure to endocrine disruptors such as bis-phenol A (BPA) and other lovelies that mess with your thyroid receptors. One side note: probiotics have been shown to reduce BPA absorption, but that’s a big topic for another post too!

If I’m making this sound as if we have the whole leptin scene figured out, let me also mention that there’s a lot we don’t know. How insulin resistance interacts with, or causes leptin resistance, for instance, is still not completely clear.

Personally, I’ve found that optimizing leptin makes my thyroid care and weight management much more successful. I’ve reversed my leptin from 11 to 4 in 6 months. As the Black Eyed Peas might put it: “Imma be Queen of my leptin, getting it down lower than 6, Imma be the flyest chick….”