Throwback Thyroid: Seeing the Roots of Hashimoto’s Staring Right At Me
Recently, my mom gave me my ‘memory box’...items that one usually gets after the death of their parent(s). She is seemingly far from death, but has always found joy not only in organizing and giving but also enjoying memories together. If one day she does indeed pass, I will not be surprised to find her place all packed up with movers scheduled!
While looking through old photos I came across a number of them like this one, with me looking like this…so very tired! Historically, I would have described myself as a teen and young adult as unhappy, unhealthy, and words I feared were true, depressed and lazy (as if ‘lazy’ is really a thing). While I was not kind to that person back then, I feel compassion for my younger self now. It's shocking to see it come back from the recesses of my memory via this box. I can feel it as much as I can see it.
What is truly startling me now though is what I clearly recognize in that face…Hashimoto’s disease! Just seeing those empty, exhausted eyes brings me right to the feeling of it–a crushing fatigue that clouded my whole existence. I suppose I haven’t seen these images since well before I embarked on a healing journey that ultimately led me to a diagnosis and a medication. A medication that changed my life. Between the time of this photo and my actual diagnosis, I improved my overall health in many ways through healthier eating, exercise, pursuing a life that inspired me, massage therapy, acupuncture and many other great things. All of that helped a lot! I kept coming back to that familiar 'faded' feeling though. Not quite so deeply, but life-altering nonetheless.
Here are some of the symptoms of Hashimoto’s disease or hypothyroidism: Fatigue (often described as ‘crushing’), depression, anxiety, constipation, dry skin, cold intolerance, brain fog, weight gain, menstrual difficulties, nerve pain, miscarriage, postpartum depression, anemia, and high cholesterol. (link) (link).
Hashimoto’s Disease is an underactive thyroid. Very simply put, the thyroid is meant to produce T4, which the body then converts to T3. T3 controls how your body uses and stores energy, which has an effect on many things. When we test the blood for T4 and T3, it’s called FT4 and FT3, ‘F’ meaning free, as in not yet bound to protein cells. PS–the thyroid also produces a small amount of straight T3, just for accuracy's sake.
TSH (Thyroid stimulating hormone) is produced by the pituitary gland in your brain and it’s what tells your thyroid to produce more T4. Similar to how the hormone glucagon tells your pancreas to release insulin when your blood sugar rises past a certain threshold, TSH is a hormonal messenger.
When TSH levels are higher than healthy, this means that your thyroid is underactive. The message is being sent out by your pituitary, but your thyroid isn't responding. Alternatively, if TSH levels are lower than healthy, this can mean that the thyroid is overactive, resulting in hyperthyroidism.
This can be a confusing part of understanding labs, and the symptoms can be similar if you don’t look deeper. For example, fatigue can be associated with both because an overactive thyroid can cause insomnia, so the fatigue could be coming from interrupted sleep instead of a sluggish thyroid. This comes into play specifically when you are trying to figure out if you need a medication dosage change, but also when seeking an initial diagnosis.
Reverse T3 (rT3) is inactive T3, or T3 in reserve. During times of stress, illness or malnourishment, the body reserves some T3 by converting T4 into rT3 until it needs it. Smart, but why don't they just call it ‘Reserve’ T3?! You can test rT3 levels if other tests are inconclusive but hypothyroid is suspected for multiple reasons.
Hashimoto’s thyroiditis is an autoimmune form of the disease and is identified by testing the thyroid antibodies. These numbers fluctuate, meaning it can take a few tests to get an accurate reading, but also that they can improve as you work on other health markers and any underlying causes. Yay for that! Not all underactive thyroid issues need to be (or should be) treated with medication, so it’s important to get a good look at this dynamic system.
Other thyroid issues that present like hypothyroid can come from the body struggling to convert T4 to T3, your cells struggling to use the T3, or a stress-related low functioning pituitary (TSH production). Given the array of possibilities, it is very important to find someone who will test and accurately diagnose what is happening.
Now here’s the rub. Current conventional parameters believe that the normal high level of TSH is 4.5-5 and they don’t test the other levels unless your TSH is elevated above that. But that ‘normal’ level is too high, so many people are going undiagnosed, or at the very least unexplored! Endocrinologists, who are in the exact position to be evaluating all of these moving parts to get people feeling better and living their best lives, just don’t. There Is conventional data coming out lowering that number some, but not to the level that most people feel best. Have we just convinced ourselves that feeling mediocre is normal? Unfortunately, at some point someone discovered that taking thyroid hormone speeds up your metabolism, so it started being misused as a weight loss and energy thing…very dangerous! ‘Metabolism’ means much more than digestion, so don’t play with that fire. It’s possible that's where the resistance to testing comes from, but that's no reason not to help people get to the bottom of it. I mean seriously, it’s a blood test!
Aviva Romm, a Yale-trained MD, midwife and women’s health extraordinaire says this:
“As many as 10% of all Americans have a thyroid problem, mostly women, and many have a slow functioning thyroid and just haven’t been properly diagnosed. In a world where medical over-testing is rampant, I have to say, I find myself confounded by the fact that so many physicians are resistant to ordering anything but a TSH – or thyroid stimulating test – as the first form of evaluation, when from a scientific and medical standpoint, that test can be normal and there can still be a low functioning thyroid. It’s outdated medical dogma to order solely this test, and I almost always order a full panel when I am presented with a patient with common symptoms of hypothyroidism.” (link).
Midwives and nurse practitioners can be an invaluable resource in testing and diagnosis. Midwives already know a ton about hormones, and some people have thyroid issues during pregnancy. Not all nurse practitioners or even midwives specialize in hormone health or are ‘thyroid literate’, but finding one who is can be golden!
Some of the consequences of not treating an underactive thyroid include goiter, heart disease and failure, peripheral neuropathy, infertility, birth defects, dementia, and myxedema coma, not to mention all of the other physical, mental and emotional results of being tired all of the time. If someone is experiencing symptoms of hypothyroidism, do the tests doc!
Again, from Dr. Aviva:
“In my practice, if my patient’s symptoms are highly suggestive of hypothyroidism, I will run the entire thyroid panel…If there are other diagnoses that are equally likely to explain the symptoms, I will run just the TSH, FT3, and FT4 while testing for other causes…” (link).
So, how do you get the tests you need? I have moved around a bit since I was first diagnosed, which means navigating new systems and the limits of them. If you have the resources you can find a midwife, nurse practitioner, functional medicine doctor or other ‘thyroid literate’ practitioner. The cost can be seriously limiting so I recommend seeing how far you can get with your insurance if you have it. It might take a whole heap of energy (which you may be running low on), but finding someone who is at least willing to order the tests is number one. Someone who can interpret them and help guide you is next up, and at different times that might need to be you. If you have Hashimoto’s that requires medication, getting an accurate diagnosis and prescription can be tricky, but once you are on it, even conventional MD’s won’t take you off of it, so the situation is easier to navigate in some ways. Ideally, you will be able to re-test every 3-6 or at least 12 months, or when you are feeling ‘off’ to keep your levels in the good zone. Your thyroid levels can fluctuate during times of stress, prolonged illness and hormonal changes (see: menopause!). I haven’t been very good at that with all of the life changes, but when I do need a dosage change (more or less), it’s always a small change and helps me feel a whole lot better.
I was very resistant to relying on something that comes from a pharmacy for a number of years after I started taking it. Numerous times I tried to wean myself off of it, but even when my lifestyle was cleaner than a whistle, I got right on that struggle bus. It was an emotional adjustment, but very worth it in the end. Whether or not you have an autoimmune form of hypothyroid, the steps you can take to improve your overall health will help. You know, the usual suspects about healthy/whole food, gut health, stress, exercise, rest, supplements and herbs. If you have it in you, start that now while you explore the roots further, but it’s okay if you don’t. Focus on getting support instead of going it all alone, and stop judging yourself for feeling like crap. That is likely part of the healing journey anyways.
All my best,
Rachael Wilder, LMT Saint Paul, MN © July 2024
Rachael Wilder is owner of Awakened Nature Massage Therapy in St. Paul, MN. She provides experienced professional massage therapy for musculoskeletal and stress-related health, uterine and digestive health, prenatal massage and postnatal massage. Licensed since 2009. www.awakenednature.com
*This blog article was written by ME, not AI!
Sources:
The Thy-Gap: Understanding Thyroid Labs When You Have Hashimoto’s. Aviva Rom, MD. https://avivaromm.com/thyroid-labs-gap/
6 Essential Supplements for Your Thyroid and Hashimoto’s. Aviva Romm, MD. https://avivaromm.com/essential-thyroid-supplements/
Hypothyroidism (underactive thyroid). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
The Gut-Thyroid Connection: Breaking the Hashimoto’s Cycle. Aviva Romm, https://avivaromm.com/gut-thyroid-connection/
The Link Between Thyroid Health and Menopause. Mary Shomon. Reviewed by Do-Fun Lee, MD. VeryWell Health, 2023. https://www.verywellhealth.com/thyroid-disease-menopause-link-3231797
Is It Safe to take Thyroid Hormones for Weight Loss?. National Capital Poison Center. https://www.poison.org/articles/is-it-safe-to-take-thyroid-hormones-for-weight-loss