Persistent Patient: Linda and the Thyroid-Gut Connection
Linda, an accomplished woman in her late 30s, was not a happy camper. She arrived for the first time at WholeHealth Chicago certain, beyond any shadow of a doubt, that she had an underactive thyroid gland. Linda had read all the websites, especially Janie A. Bowthorpe’s Stop the Thyroid Madness, and was becoming increasingly exasperated with conventional medicine.
“Here,” she said, handing me a well-worn list that looked like it had been in other medical offices, “I’ve written down all my symptoms. I’m tired and cold. My skin is flaky and my shower drain is clogged with hair. I eat barely anything, gain weight, and it won’t come off. Look at this list! Constipation. Bloating. Heartburn. Brain fog. See my eyebrows? See?”
“And it’s because of these…” she pawed through the chambers of a large handbag and extracted some papers, “…these goddamn normal lab tests that no one will prescribe me some thyroid.”
Indeed, her tests were normal. Linda didn’t even have the antibodies that would diagnose her with Hashimoto’s disease, in which the thyroid is attacked by the immune system, leading to an underactive thyroid. At least there are some doctors who will now prescribe thyroid hormone based on the presence of Hashimoto antibodies alone.
I didn’t even bother with pleasantries
No “Hey! Welcome to WholeHealth Chicago!” or “How was traffic?” or “Is Streamwood a nice suburb?” Linda wanted to get down to business.
So I asked if she had taken her basal temperatures.
Low basal temperature—which is your temperature as you emerge from sleep, before you even move from your bed–has been linked to underactive thyroid for 100 years. But because conventional medicine is fixated on blood tests, measuring “basals” has become an underappreciated diagnostic tool. Instructions for taking your basal temperatures are all over the internet, including here at our WHC website.
Linda: (more scrabbling into her handbag) “Of course, of course…right here.” She palpably refrained from blurting out “Do you think I’m an idiot? Of course I did my basals!”
Her basal temperatures showed she was cold as ice, but the tired and sluggish Linda was pleased as punch as she headed to the CVS with my Nature-Throid prescription. Nature-Throid is a completely natural thyroid product, same as the old Armour thyroid before Big Pharma mucked it up. I asked her to report back in a month.
Linda returns, much better, except for…
(A new) Linda: “I’m better, really I am better. I had to double my dose–you don’t mind, do you? I felt so much better taking two tablets. And almost everything is better–energy, I can think again, not losing hair, and I feel warm. I’m not even constipated any more.”
Dr. E: “Uh…um…”
Linda: “It really won’t hurt me taking two pills, will it? You’re not angry, are you?”
Dr. E: “Uh…no, but I’d really rather…”
Linda: “I mean about doubling the dose. I won’t do it again, promise.”
Clearly, the thyroid replacement had perked up her brain, but she wanted everything even perkier. I reassured her that I’d check her thyroid hormone levels to ensure she wasn’t taking too much and hadn’t inadvertently made herself hyperthyroid (when the thyroid is overactive). I did ask Linda not to go any higher, reminding her that her original thyroid tests had been completely normal.
Linda: “But one symptom is left. I’m as bloated as ever. My friends even say I look pregnant after we have lunch together.” (I know people express their opinions openly these days, but can’t imagine sitting with someone for lunch and when rising from the table blurting out “Wow! Look at your stomach!”)
The thyroid-gut connection
Remember that the hormone your thyroid produces acts as your body’s gas pedal. If the thyroid is functioning normally, everything in your body is clipping along at a normal pace: heart rate, thought processes, energy level, digestive tract, and so forth. If you have an overactive thyroid, everything is speeded up. With an underactive thyroid, everything s-l-o-w-s d-o-w-n.
Linda’s low thyroid had led to a sluggish digestive tract (constipation, GERD/heartburn), but with the Nature-Throid prescription she was returning to normal, except for the bloating.
Some people with Hashimoto’s improve when they go gluten free (GF). Since Linda did not have “Hashi’s,” I didn’t ask her to try this. If you’ve ever tried eating gluten-free you know it can be a real challenge (although with that said, many people feel better off gluten). I’m chomping on a bagel and cream cheese as I write, getting crumbs into my keyboard. The thought of a GF bagel is not thrilling.
Since Linda’s one remaining symptom was the bloating, I was tempted to suggest she try eliminating gluten for a while to rule out what’s called non-celiac gluten sensitivity, but some recent research suggested I pursue another course.
Low thyroid (hypothyroid) and SIBO
It makes a lot of sense that hypothyroid patients would be more susceptible to bacterial overgrowth in the small intestine than the rest of the population. Remember, with everything slowing down in hypothyroidism this includes the movement of your small intestine. Linda had been constipated (sluggish large intestine) and had heartburn (sluggish esophagus and stomach). By taking thyroid hormone, her entire gastrointestinal tract was moving again. But because her small intestine had been so sluggish, bacteria had set up house, and now didn’t want to leave.
I wrote about SIBO (small intestine bacterial overgrowth) in a previous Health Tip. In this common condition, intestinal bacteria produce gas when exposed to certain foods. We can test for SIBO by measuring the levels of these gases in your breath.
A medical article in 2014 reported that more than half (!) of hypothyroid patients probably have undiagnosed SIBO. I gave Linda a breath test take-home kit. When her report came back from the lab it looked a lot like this one. I saw immediately why she was bloated and called in a course of antibiotics, to be followed by probiotics, to clear it up.
Linda is now feeling fine, though I had to tell her that SIBO occasionally requires periodic re-treatment. If there’s a moral to this story, it’s to be a persistent patient (Linda herself saw half a dozen physicians before she came to WHC). Stay informed and challenge the system. Squeaky wheel and so forth.
Oh, and if you’re both hypothyroid and bloated, get yourself tested for SIBO. Vice versa applies. If you’re chronically bloated or have been diagnosed with SIBO, have your thyroid function checked.
David Edelberg, MD