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Persistent Patient: Linda and the Thyroid-Gut Connection

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.

Be well,
David Edelberg, MD

Leave a Comment

  1. MKGilbert says:

    NatureThroid made me more anxious, so, even tho it hasn’t seemed to help with the chronic fatigue for the the past 20 yrs I’m still taking Levothyroxin…been of .75 mg all these yrs…At least it’s not an expensive med as is the name-brand Cymbalta that I take…

  2. Beth says:

    This is a great article, Dr. E., and my Hashimoto’s is currently well managed with Nature-Throid, which you prescribed for me. However, it took years and I developed other health problems, one significant and very painful. I was one of those persistent patients you describe, but after years of educating, challenging and debating, I hit the wall. I now assertively tell doctors they need to do their jobs, do the research. I certainly understand why you tell us to stay informed and to challenge the system, but somebody needs to advocate FOR US, and tell the doctors to stay informed, stay on top of their specialties. After all, we feel pretty rotten a lot of the time, and we are not paid to do the doctors’ work. I realize what I’m saying will probably happen when hell freezes over, but I’m sure you know of the many patients who just throw their arms up, and then go back to the couch and zone out.

  3. Liz Strause says:

    My new Blue Cross Community Health Insurance is refusing to pay for my Armour thyroid. Frustrated.

  4. John says:

    This is another great example of how everything in our system is connected. I’ve been on Nature-Throid (prescribed be Dr. E.) for a few years and it does seem to have helped my energy. I also have occasional flares of mild psoriasis and have a few flares of ulcerative colitis. It all seems connected. When I have inflammation under control, all the flares calm down. It can be hard to keep it under control, and I keep working at it, and I greatly appreciate WHC and their wholistic approach.

  5. PR Lundy says:

    Dear Dr. Edelberg, I am a fan of your work so I’m a little surprised at your inappropriate use of the word “normal” in regards the thyroid function tests. A result within the reference range does not, and in fact cannot, guarantee normalcy. A reference range is diagnostic only if the width of the patients RRs is close to the width of the population RR. With the thyroid function tests a patient’s RR is 1/2 to 1/3 or less than the width of the population RR therefore the only real accuracy is at the extremes and even that is questionable. Doctors almost universally make a false assumption about the degree of accuracy of the tests because the results are labeled ‘low, ‘normal’, ‘high’ and any result in the ‘normal’ range is taken literally. The TFTs are not capable of that degree of accuracy. It is unfortunate doctors are not taught the science.
    This false assumption sends patients on a wild goose chase down the trail of tears and lost years. I have the science if you would like to read it. Respectfully, PR Lundy

  6. Kathleen A pepsnik-good says:

    I trashed my “no regrets ” article you wrote for the
    New year. Mistake- please Dr. Edelberg email me
    That article . I had a yearly visit with you 2 weeks ago
    Told you how much that article helps me . Many issues in my family – I use to read it often for getting my mind in a better place. Thank you very much

  7. Dr E says:

    Hi PR
    I think you missed my point re “normal.” I am very much opposed to doctors’ reliance on “normal” and believe most physicians forget what they learned in medical school, namely to treat the patient and not the lab test.
    I am in full agreement with you that a “normal” result may not describe what is actually happening

  8. Brent Petetson says:

    Fantastic story. I knew it well. 4 years, lots of doctors, and a stool test I needed to advocate for revealing 3 opportunistic bacteria, virtually no L. Bacteria, and little pancreatic enzyme activity. even with this, the docs are unimpressed as a source of my fatigue, fog, ibs, and anxiety? Am I crazy or are they?

  9. Daryl H says:

    Well, Dr Edelberg, I have been your patient for five years, am extremely motivated and persistent and I am still tired and still getting migraines all the time, along with hair falling out and constipation, just like this patient, and I am on Naturethroid. I am always delighted when I read one of your stories about how you figured it out for someone, but regrettably I am not one of those.

  10. Angel MC says:

    With respect to Dr. E for tackling this topic and giving Desiccated Thyroid Extract (DTE – NatureThroid, WP Thyroid, NP, Armour) positive attention, I will add that, for people that must rely on thyroid hormone replacement, there is no “normal” in thyroid levels results and in dosing of the THR.

    For those of us whose bodies are “poor converters”, our bodies inadequately convert the T4 into T3. To make up for the lack of conversion, we must rely on T3. We want to be able to thrive, not just survive. Scientists and researchers are gradually discovering and hesitantly revealing that the issue can be caused by a genetic flaw. Due to doctors not knowing about what really constitutes “your levels are normal/good”, many people are misdiagnosed as their symptoms are being attributed to anything but thyroid-related issues.

    Another issue is that DTE manufactures list the equivalence chart for DTE much lower than what is truly needed by the body. A normal, healthy thyroid will release human thyroid hormone as needed (pituitary/thyroid axis). For those of us that are using a T3 pill (synthetic or DTE), we find that we feel better and have more stable energy when we split our DTE doses. This is due to the fact that we have to ingest, digest, process our THR differently than people with healthy thyroids.

    Most of us that found relief and better energy by using DTE have thyroid hormone levels wherein the FT4 is lower-in-range and the FT3 is higher-in range. I, and some of my friends with medical backgrounds that also have no thyroids, would be happy to discuss further with you.

    Thank you for your contribution to promoting use of DTE and sharing the experience of your patient.

  11. Patricia Woodbury-Kuvik says:

    As a thyroid cancer patient advocate I appreciate when physicians and other health professionals are more specific in their writing. The lab reference values considered to be “normal” are quite wide, even though thyroid hormone dosing is done in micrograms. On our forum we constantly see symptomatic people (following thyroidectomy) with values in the low end of the range for Free T4 and T3, high FT4 but low FT3 or are being dosed by TSH level alone. Many physicians fail to understand how to evaluate Free T3, they are taught by the ATA that TSH alone is the gold standard and sufficient for diagnosing and treating. There is so much wrong with the way much thyroid dosing and testing is done. But, while clinical evaluation and response *should* be the gold standard, it’s also important to do the correct lab work to evaluate response to thyroid replacement hormone and rule out related issues as cause for symptoms (such as vitamin/mineral deficiencies).

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