----
Intro to Ferritin/iron
Ferritin is stored iron in the body that is released over time. Ferritin can be high or low, and both can be bad. Be sure to have your ferritin tested before supplementing with iron. Do NOT take any iron supplements for one week before any type of iron lab work if just starting, later on you can look at ferritin rises differently but to get a baseline start without taking iron.
Ideally ask for the full iron panel PLUS ferritin. Labs have differing groupings but usually put ferritin as a separate lab that is outside the iron panel. Hopefully your physician will order all to work with you on this area.
Optimized values for Ferritin, (ONLY for thyroid medication users):
Male around 60-80 ng/mL
Female 50-70 ng/mL
Ferritin is just storage iron or one type of iron measure. This is NOT the same as a person not taking thyroid medications, where a ferritin level about 50-60 ng/mL is fine.
Although ferritin issues are the most common thyroid medication connected to iron levels issue, you should also consider getting your doctor to run a full iron panel. This has additional checks for anemia, iron deficiency and more. A percent saturation of less than 33% or elevated TIBC or UIBC are iron deficiency indicators. But again do NOT take any iron supplements for one week before any type of iron lab work. Other things that change the iron panel results making them invalid can include birth control pills, consuming lots of meat before the lab, and various inflammatory conditions. Iron testing has to be done very carefully with some considerable preparation, it is not uncommon to not be informed on how to prepare properly for an iron panel. The other iron labs can have error fairly often and can need repeating.
----
LOW Ferritin
Aside from low Free t3, low ferritin or storage iron often connects to hair loss, low energy, poor thyroid medication utilization and many other issues. When storage iron is low, such as a ferritin level of 10 or 18 or other low value, the body creates reverse t3 out of T4 and it goes straight to T3 receptors. This is particularly true in places like hair follicles, but generally everywhere in the body. The reverse t3 blocks up t3 receptors and you feel off. This is because the body is thrown into a kind of preservation mode from low iron stores. This is most linked to ferritin, even if the other iron tests are better or more normal values. Importantly this happens even at the so called "low normal" of the ferritin range, though I don't think there is an exact value it is known to start happening.
If the ferritin is quite low, IV iron infusion is the easiest way to boost.
Real easy to buy iron and works super well:
http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=VS-2606
Also to buy: cast iron pans or cookware, use them.
Iron to avoid: ferrous fumerate, ALL multivitamins with iron.
Note that long term taking of multivitamins with iron is associated with colon and GI cancers. The idea of boosting iron is boost awhile and go off awhile, thus supplement with something other than a multivitamin. Decades of taking multivitamins with iron increases colon and GI cancer risk.
If you are iron deficient you should have a complete blood count (CBC) with Hemoglobin and Hematocrit to check for anemia.
-----
HIGH Ferritn
If ferritin is too high donate blood, this can bring the levels to those mentioned above. If it is extremely high that is a condition called hemochromatosis.
Here is a link to Uptodate (used by many docs as a reference) info on hemochromatosis:
http://www.uptodate.com/contents/hemochromatosis-hereditary-iron-overload-b eyond-the-basics
It is common amongst southern European/ Mediterranean descent individuals. Here is the key statement from UptoDate:
"Ferritin levels greater than 300 ng/mL in men and 200 ng/mL in women support a diagnosis of hemochromatosis. However, ferritin levels can also be increased by many common disorders other than hemochromatosis"
---
What is rT3?
Reverse t3 (rT3) is a primal response of our bodies sensing something wrong, and forcing a slowing of metabolic rates in an attempt to create a somewhat hidden self preservation mode of sorts. Basically your body attempts to slow metabolism when it senses you are ill, deficient in iron, minerals, vitamins, other hormones, or otherwise have something off or wrong. Having a high metabolism when ill would not be a good thing in general, so we developed an internal system to slow metabolism at these times. Symptoms sometimes may include hair loss and fatigue not resolved by raising FT3 alone.
Basically rT3 blocks T3 receptors all over the body and the Free t3 can't get in. So you will feel quite poor, sometimes even presenting with a good FT3. rT3 looks similar to T3 to the body but it can't function like T3 at all. It blocks the active thyroid (T3) hormone from being used since receptors are blocked up by the rT3 molecule. We then expend less energy, but we won’t feel well. All people have rT3, one can never get rid of all of it. However when rT3 is really high, that is when our body has kicked into its mode of forcing a slowing metabolism. We can potentially correct situations of high rT3 by finding the source of the problem.
The most common source of the rT3 issue is iron deficiency or storage iron deficiency (ferritin) and any related anemia's even if mild. Storage iron (ferritin) when deficient or even just low can cause the body to go directly into preventing thyroid hormone utilization, or the metabolic preservation mode. Add to that problems in hematocrit, hemoglobin, RBC counts, and we might end up with anemia as well. The body starts with sensing that something is wrong with low ferritin, and then rT3 spikes up till iron stores go back up (better diet that includes iron). But in the mean time we feel off sometimes even with a good FT3 because our body is in a hidden self preservation mode.
----Basics of MTHFR-----------
Just the basics, no personal claims on any info just something I learned to start dealing with. Most doctors won’t help too much with this, but it could be a factor for some. Inputs/changes welcome.
Methylene tetrahydrofolate reductase (MTHFR) is when your body builds up toxic levels of folic acid (man-made synthetic form), and you lack enough of the enzyme function to convert it to the active and natural form Folate (Vitamin B9 a.k.a. methylfolate). The un-natural and fully synthetic Folic acid is added to wheat and many other products in the USA, just tons are in cereal, bread, other products. I have even seen it added to dried fruit. If you don’t convert it to folate very well due to some genetics you may have, it builds up and becomes toxic, then after decades of running very high levels it can cause issues (toxicity)
Some of the symptoms of too much folic acid/toxicity - you might get variations or just some
- Thyroid issues are very common
- A feel that for some is just like acid reflux, one that actually is caused by low stomach acid – working in Betaine w/pepsin during meals is the often the answer and not proton pump inhibitors. Even if you don't get the reflux feel most everyone gets low stomach acid.
- Sensitivity to medications/pill fillers
- Autoimmune issues
- Depression - Some people get an anti-serotonin effect
- Foggy thinking in some
- GI issues and or problems, food sensitivities
- Prostate or endometrial/uterine issues
- Metals – Some may get higher metal levels because they might absorb them more than average person, so testing for some metals advised by some websites – arsenic, copper, mercury, lead, cadmium
- MANY more issues
What happens is the low stomach acid can't break down various molecules and they absorb down in the GI below the stomach, which normally they wouldn't because they would have been broken down. This lack of ability to break things down from low acid, then causes the various food and pill filler or additives sensitivity.
The easiest cure for some - Simple solution
- Stop buying/eating food with folic acid added, this includes cheapo multi-vitamins and enriched wheat (just enriched wheat, not all wheat).
- Buy Betaine w/pepsin and take daily in the middle of food but only with big meals, AM and PM meal suggested, or at your largest meals of day
---------------
Some lab tests of note you can ask your primary care to run - may help some in more complex cases
Keep in mind never take biotin the week you do labs.
- Homocysteine. If your homocysteine is above 10 (don't use the range - use above 10), that is indicative of issues. Most people the homocysteine should only run 7 or 8, not 15 or 16 or some number like that.
- “Folate” lab. This lab does not break down synthetic and natural (methyl) versions of Folate. So it is a gross measure of all forms. It should only test some value like 6 or 7 (ng/mL), if you read >14 or >20 (ng/mL) or any other value that has no upper limit it is too high. RBC Folate is sometimes said to be a better measure than Folate.
- Genetic test, you can ask for one if you can find a doctor willing to order. You can also use the promethease website to upload ancestry raw DNA file, or 23 and me file, then look it up for yourself (more advanced and you need to learn the nomenclature of genetics).
------------
More complex solution - if the simple solution does not work
1. You can avoid folic acid added to your food, this includes cheapo multi-vitamins and enriched wheat products (wheat is ok, but not enriched wheat). At first it is hard to find foods in stores but eventually you find replacements to the added folic acid foods and enriched wheat.
2. Betaine w/pepsin. Take daily in the middle of food but only with big meals, AM and PM meal suggested, or at your largest meals of day
3. Akkermansia - probiotic
4. Follow this link on supplement amounts (regimen)
https://foodforthebrain.org/nutrition-for-healthcare-professionals/homocysteine-b-vitamins/
5. My advice is just eat foods with natural folate and not bother with a high dose supplement. If anything a multivitamin with methylfolate.
6. Every year have a Homocysteine and Folate lab, if elevated follow foodforthebrain link suggestions again.
7. Humic Fulvic acid complex, you may need it for gut healing.
------------
The
MTHFR gene sits on Chromosome 1. It only matters if you build Folic
acid up and get issues, this is an estimation of your loss in ability to
convert folic acid to folate based on the genetics you might have. Source.
Heterozygous = 1 copy of the gene from either parent
Homozygous = 1 copy of the gene from each parent
MTHFR C677T Heterozygous = approx. 40% loss of function
*MTHFR C677T Homozygous = approx. 70% loss of function *
MTHFR A1298C Heterozygous = approx. 20% loss of function (research not known)
MTHFR A1298C Homozygous = approx. 40% loss of function **
MTHFR C677T & MTHFR A1298C heterozygous = compound heterozygous = 50% loss of function
------------
More Info/references to read
Food for the brain
https://foodforthebrain.org/nutrition-for-healthcare-professionals/homocysteine-b-vitamins/
----- BONE and JOINT----------
Combine a moderated FT4 with good FT3 with the below
Two bone booster
1 A nice collagen mix to take as desired. Your favorite collage powder mix - mix below into it
- Boron liquid drops
- Biosil liquid drops
- If you tolerate Magnesium like a citrate it is a powder and can mix in - I can't handle magnesiums well so it isn't for everyone
2 Then buy yourself a D3 with K2 that also has strontium, they sell that as a single pill d3, k2, strontium.
----
Introduction to Cortisol from a naturopathic through medical point of view
Cortisol is at its peak 30 minutes after you awake and declines all day so to see an issue you need multiple samples. Many of us try the salivary cortisol test which is done 4x a day from Canary Club (mail order). There is natural variation and one can see that in a graph where normal has upper and lower for any time point on the graph.
http://www.canaryclub.org/
Just be aware many naturopaths and even a few doctors will try to treat cortisol without good testing. I would never advise that. If you go to a doctor or a naturopath and they try to treat cortisol levels without a real substantial set of testing that was carefully done you should not take their advice. Cortisol can be high or low, so the wrong treatment will make a bad situation much worse. Nor should you just buy any kind of adrenal booster or adrenal support product without being certain what the problem is, how much of a problem there is, and which items in the product are known to help. There are hundreds of these products out there and many people take them without this information, this is not generally a good thing to do.
----
LOW Cortisol
a.
If cortisol is modestly low at points of the day one can take licorice as a tea or supplement for awhile , please note that is not long term.. The licorice must have glycyrrhizic acid as some sold that is removed. This will stimulate a re-start of the adrenal system. Licorice can raise BP for some people. The length of time people take licorice varies by various sources of recommendation, but one should not take it indefinitely. See more on licorice below.
If cortisol is really low you have to see a doctor to check for Addison’s disease or adrenal insufficiency:
Adrenal insufficiency test (very low cortisol)
http://en.wikipedia.org/wiki/ACTH_stimulation_test
b. How does licorice work?
Licorice/glycyrrhizin is used to raise cortisol. Lots of articles about it, they all differ in amounts, how long to take, etc. Licorice mimics desoxycorticosterone or ACTH, thus one gets a cortisol boost from it. The theory is when a person has low cortisol you stimulate with an ACTH like effect for several weeks/ or month with licorice and the body kicks back in and resumes its more normal cortisol cycle and you discontinue licorice. It is a kick to the system basically. One should never take licorice for long periods, this is why candy can't be sold with real licorice because long term use is dangerous.
This does not cover it all but covers how it mimics ACTH or the theory of what is used and described in many articles and books for using licorice to raise cortisol. This is a published article so it does not cover an implementation but essentially the method of action, mimic ACTH:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2136773/
----
HIGH Cortisol
Oppositely if cortisol modestly high you can take Holy Basil which is a supplement to lower modestly high cortisol levels. Holy Basil got is name because monks in India wanted to de-stress or remove cortisol.
If cortisol is very high you have to see a doctor to check for Cushings syndrome:
Cushings syndrome test (very high cortisol)
http://en.wikipedia.org/wiki/Dexamethasone_suppression_test
----
Vitamin B-12 Basics
Goals
B-12: 800 pg/mL
Vitamin B-12 is the energy vitamin, when it runs low or low in range you may feel off. Low values can lead to fatigue and anemia. Similar to Vitamin D when Vitamin B-12 is high in the range one seems to feel more steady over the whole of the day. One generally feels much better with a very good normal vitamin B-12. Methylcobalamin is the active form and is more absorbable, sprays and sublingual’s are recommended. As with all B vitamins suggest the active B forms. Mary Shomon covers it well:
http://thyroid.about.com/cs/newsinfo/l/blb12anemia.htm
-----
What about Selenium?
Selenium and Zinc are supplements described as helpful in converting T4 to T3. If you want to look into this, be sure to have some or tests before supplementing (ask your doctor to test the level). Be sure you do not have a multivitamin with sodium selenite or selenium selenate as these are not just bad but harmful to the process. Be sure if your vitamin has it that it is selenomethionine or selenium yeast (and a few newer ones), or buy as a separate supplement. I would not overdo selenium or selenium supplements, as excess is bad. Many supplements make it too easy to take too much, and you don't want that.
Much variance in amounts to take in articles. One brazil nut has roughly about 90 mcg IF it was actually grown in Brazil and is unprocessed (raw), but if it was grown somewhere else it might not have that much. Many articles mention 200 mcg a day as a supplement, but this may actually be too much if you get plenty with food already. I would say 25 to 50 mcg is fine, unless you test low.
Post TT there is no consensus on amounts to take, or if it truly helps. As is so often the case in thyroid related issues, more a lack of good articles if you want scientific ones following clinical needs and goals such as for a thyroid patient or thyroid cancer patient who just needs to know what to do.
Selenium is the first thing I ever tried when I was super high Free t4 and just not feeling well after TT. It might have helped a bit, I don't think it really pushed my T3 up. At most I got a minor bump on T3 levels. So I don't think it was my issue but it is just one thing we can do among many. Selenium deficiency is more connected to Hashimoto's as far as I can tell, and I never had that. But there are many general links one can read.
Chris Kresser (type of integrative medicine practitioner) info in link below. He is positive somewhat on selenium overall, has some references, but also some warnings on selenium:
http://chriskresser.com/selenium-the-missing-link-for-treating-hypothyroidi sm
A solid NIH reference
http://ods.od.nih.gov/factsheets/Selenium-HealthProfessional/
----
Iodine (optional)
You probably got thyroid nodules because you had a low iodine condition at points in your life. Nodules or goiters are associated with low iodine and this has been known for over 100 years. People get low iodine, not only because our diet is low in iodine in the US but because fluoride and bromines block it in our body.
Iodine isn't just used by the thyroid but it isn't used in a process like a vitamin or glucose. Outside the thyroid it is most commonly linked to mammary gland and clearing calcifications, thus a removal type process. Deficiency is often linked to fibrocystic breast tissue. Iodine reading and discussions are unfortunately in two camps, the ultra mega-dosing though it can benefit a few, and those who say only the thyroid needs it. Try to avoid those camps at first reading if wanting to read where you fit in.
If you take iodine, you should also take adequate selenium, or try to be sure you are not selenium deficient. Iodine without sufficient selenium levels is associated with autoimmune thyroid disorders.
-------More Links and Info---
Where to get Free t labs:
If docs won’t order, first look for a doc that does, but you can order your own, the links keep changing so I can only post a general link and even that might not work:
Posted on Inspire by reneeh63
https://www.healthonelabs.com/
There is also mymedlab.com :
https://www.mymedlab.com/
posted on Inspire by Nature_throid and others:
https://www.directlabs.com/
Canary Club which is great for cortisol and others, but their thyroid labs are too differing to compare to LabCorp for example in my own experience (experience may vary):
http://www.canaryclub.org/
----
Links to more info and sources of much of info
These are all websites, some by book authors who are well known for their work/research/papers/books. Dr Shames, Dr Holtorf, Dr Bianco, Mary Shomon, etc
NAH – National Association of Hypothyroidism - great graphics. The best clinical resource found:
(sorry now defunct)
Hope for the future, BiancoLab
http://deiodinase.org/
Mary Shomon – outstanding author (links not working)
Dr Shames related – one of original authors on more than just T4
http://thyroidpower.com/
Dr Holtorf related links
http://www.holtorfmed.com/
----Links to doctor lists---
Your local pharmacist can sometimes tell you physicians in your area that prescribe NDT/DTE.
When you get to the actual physician list click on a heading like "state" to sort by state or province, etc. Scroll down to your state. Kind of not the best web interface to a list, as some have trouble getting to doctors in a specific state, but work with it a bit and you will get the doctors in your state:
RLC labs links, location keeps changing on website making this link difficult to give. See "Find a doctor"
https://getrealthyroid.com/
NP Thyroid "Find a doctor"
https://npthyroid.com/
Posted by emmaleah, finding docs by prescribers:
http://projects.propublica.org/checkup/
One way to make it work is go to say "Armour" or "Liothyronine" in the "Top Drugs" list, then go into that by clicking into it, then click on your state on the left and it shows the most to least prescribing doctors of that exact thing. So if you want Armour in your state you have a list of docs that do it. But they have to do at least 50 prescriptions of it I guess.
Slightly older and no longer updated, but still valuable:
http://www.thyroid-info.com/topdrs/index.htm
Functional Medicine, Select MD/DO, enter zipcode. Posted by snova68
https://www.functionalmedicine.org/practitioner_search.aspx?id=117
Some osteopathic physicians will look more into T3 and T4, some but not all (link not working well)
http://www.osteopathic.org/
Naturopaths in some states can give prescriptions.
The states that license Naturopathic Doctors or Naturopathic Physicians are Alaska, Arizona, California, Colorado, Connecticut, Hawaii, Kansas, Maine, Maryland, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, and Washington DC. In licensed states NDs practice as independent primary care general practitioners, with the ability to diagnose and treat medical conditions, perform physical exams, and order laboratory testing. In these states many health care consumers specifically choose NDs as their primary care providers. Select Adrenal/endocrinology disorders and enter zip code.
http://www.naturopathic.org/AF_MemberDirectory.asp?version=2
WorldLink
https://worldlinkmedical.com/directory?&tab=2
Hypothyroid mom lists
http://hypothyroidmom.com
Thyroid Nation list
http://thyroidnation.com/thyroid-friendly-doctors/
