RHR: Is it Possible to Get Off Thyroid Medication?



hey everyone welcome to another episode of the revolution health radio show this show is brought to you by Chris Kresser calm I'm your host Steve Wright from SCD lifestyle calm and with me as integrative medical practitioner New York Times bestseller and healthy skeptic Chris grosser I didn't man I'm right Steve how are you I'm doing good I'm reintegrating back into life yeah but I want you to tell everyone a little bit about what you've been up to these last couple weeks okay well if depending on how the sound comes out I apologize everyone they're doing massive construction outside of my new apartment and I'm in the kitchen right now trying to find the best acoustics but so yeah I went on a 10-day meditation the pasta meditation retreat and that form of meditation retreat means absolutely no self-expression so no talking no writing no exercising you just meditate for approximately 12 hours a day and the only people you can talk to are the teachers or the management staff so that wrapped up about five days ago and yeah it was it was transformational it was one of the hardest things I've ever done no doubt but so worth it and and so amazing I don't I don't think words can really express what I've gotten from it yeah I know what you mean it's such a powerful like you said transformational experience and it's it's it's a big commitment to make but as you you know as you shared with us I know from my own experience there's there's really nothing else like it there's no other it's such a precious gift to give yourself so I'm so glad that you did that thank you yeah I I really I knew I didn't know myself but you know just getting to spend some time with yourself I think was so so amazing in that you know I know that there's lots of different forms we've talked about it on the show a lot and I have to thank Chris for continuing to talk about meditation or in the basis because I don't think I would have ever ended up going to this Chris without you being friends and without us without me hearing over and over again that this is something that a lot of people should check out so I appreciate it Chris oh my pleasure and yeah it's you you're the one that made the commitment and did it and it's it's really amazing to see what comes up when you're just sitting there on a cushion you have no distractions none of our typical things that we do to distract ourselves from what we're feeling or thinking it's quite a valuable experience isn't it today I had coffee cold brewed coffee with some cream so was it it was a intermittent fast day I just didn't feel particularly hungry when I woke up had kind of a late dinner I knew I was gonna be recording and so that was it is that robbery this is from this is actually pastor ice cream from Straus Dairy which is a passion local pasture-raised dairy I do like a flash pasture pasteurization pastured dairy that does flash pasteurization yeah so it's we do get rock cleaned sometimes but Straus is pretty good when we can when we can't get the rasta awesome yeah so we have a great question today I think it's gonna be relevant for a lot of people so we'll give it a second to playing and then we'll answer it for the rest of the show hi Chris this is Raven love your show I wanted to know if you think it's possible to get off thyroid medication . i do not have Hashimoto's i've always tested very very low end bodies but have had a conversion problem for at least the past ten years originally when I was put on medication my t4 levels were good but my t3 was very low now that I've been on medication I'm currently using nature thawed and some site ml and I'm trying to lower the dose my TSH does not kick back in so it stays at a very very low level point zero seven even when my p4 drops way below the normal force is there any way to gradually get off medication or should I just resign to my fate I have felt some improvements some ability to use less thyroid medication as I've been working to heal my gut which of course is not very surprising still I love some words of wisdom and insight thank you very much okay well thanks for your question Rayven there are actually several different issues to address here in this question it's probably at least four so hopefully we can get through those in this episode and if not we'll circle back and and finish it off another time all right great so I you know the first question was was there made one which is is it possible to get off thyroid medication another question or issue to talk about is our antibodies really reliable in diagnosing Hashimoto's in the first place and if they're not what is a third issue would be what what causes the problems that we see with conversion of t4 to t3 so what causes t4 to t3 conversion problems in the first place and then a secondary question there would be is is medication the best way to treat those problems or causes and then number four would be what does a TSH of zero essentially zero zero point zero seven and low t4 indicate when you're taking thyroid medication so as is often the case you know when we when we look at some question like this it becomes a lot more complex that it may seem initially on the surface so let's tackle issues number two through four first because they're actually going to inform the answer to the first question which is is it possible to get off thyroid medication so in terms of diagnosing Hashimoto's it's actually not quite as straightforward as just doing an antibody test and seeing what the results are I wish it were it would it would make my life a lot easier for sure but the the first-line tests you do typically want to do is for antibodies and by antibodies I mean thyroid peroxidase and thyroglobulin antibodies these are the two antibodies that tend to be elevated in Hashimoto's and thyroid peroxidase is elevated a lot more often than thyroid globulin it's more sensitive and more specific Daanish emoto's it's a it's more sensitive it's actually not more specific but it's more sensitive so you'll tend to see it elevated more frequently but the probative means anything above zero or lab range elevate i do use the lab range i know some practitioners will say anything above zero is abnormal but i don't actually think that that's true when you look at any kind of antibody test even cyrex labs for their their array number five multiple antibody screen or any of their gluten intolerance panels or whatnot you see that a small amount of antibody production is actually not pathological or or abnormal and so i don't know what the scientific basis is for claiming that thyroid antibodies being anywhere above zero is is abnormal or indicative of pathology because i've never seen any research to back that up so I used the lab range if it's getting close to the top of the lab range I will definitely be paying attention because the the cut-offs are always somewhat arbitrary you know they're based on research and prospective studies and I've seen some prospective studies that suggest to me that the lab range should be perhaps a little bit lower than it is like with with thyroid peroxidase it's usually 34 is the upper end of the limit or somewhere around there I've seen studies suggesting that if you have tpo antibodies above 30 you're much more likely to develop hypothyroidism in the future so it's possible that the lab range should be a little bit lower but I don't think it should be zero the problem with thyroid antibodies is they're not like most almost any lab tests that you can mention they're not 100% reliable as a way of diagnosing Hashimoto's so for example in a study of a hundred South Asian Indian people that had Hashimoto's confirmed by histological analysis meaning actually looking at the tissue and seeing for sure that they have Hashimoto's about eighty-nine percent had tpo antibodies and 65 percent had thyroglobulin antibodies so that means that 11 percent of people with Hashimoto's would have been missed in that if you were only looking at TPO antibodies and a full 35 percent of patients with Hashimoto's would have been missed if you were only looking at the globulin antibodies and there are other studies that have actually even shown lower numbers so it's more like 75 to 80 percent have have TPO antibodies and as low as 40 or 45 percent have favor globulin antibodies so what we can say from these numbers is that anywhere between 11 and maybe 30% of patients if you run tpo and thyroglobulin antibodies that have negative results on an antibody test may still have Oishi motos even if you run that antibody test multiple times so that's really important for clinicians understand because you know I've seen a lot of patients who've gone you know I've been to a doctor a few times before they come to see me and they said no I don't have Oscar Moto's I had an antibody test and it was negative well you can't really conclusively rule it out just from an antibody test or two so did I hear you correctly that with these people you could potentially do the antibody test ten times or even a hundred times and they might never know they might never show positive I don't know about 100 possibly ten I think it's a lot less likely if you do multiple tests which is why I always recommend that people do two to three tests over time at least to see if we can catch it and I have seen that with patients where they've come and they've had one or two negative tests I test them a third or fourth time and we we catch the antibodies elevated on the third or fourth time and but even then that's not necessarily indicative that hypothyroidism is present or will ever be present so that's another important thing to understand that Hashimoto's itself is not doesn't necessarily mean that you have an under functioning thyroid gland it means that there is some that your immune system is tagging the thyroid gland for destruction it doesn't even necessarily mean that destruction of the tissue is occurring actively and those are all not necessarily connected they're likely to be connected but they're not necessarily connected there's a certain percentage of patients and I think it's actually over fifty percent who produce antibodies thyroid antibodies that don't go on to develop you know frank hypothyroidism of course people with thyroid antibodies have a much higher likelihood of developing hypothyroidism in the future in fact it's over Sevenfold I think seven and nine fold greater risk than people without antibodies but it doesn't mean that if you have antibodies that you a for sure right now have hypothyroidism or B will ever develop hypothyroidism so that's that's important to understand as well another test that you that your doctor can run typically an endocrinologist will do the this test is a thyroid ultrasound so they'll read an ultrasound on your thyroid gland in your neck area they look for what they're looking for typically are nodules little bumps on the on the thyroid gland especially if you have like a multinodular goiter like a little mild swelling with a lot of a lot of little nodules there that's indicative typically of of an autoimmune pattern Hashimoto's or if you have hyper thyroid type of symptoms Graves disease so if you really want to get the best view of whether you have Hashimoto's it's best to combine it's good to combine the antibody testing with a thyroid ultrasound of course they also you know you could do a biopsy which would be the the most accurate way of detecting Hashimoto's but that's very invasive you know sticking a needle in your neck and aspirating tissue there is not very appealing and as is potentially dangerous and given the the fact that Hashimoto's is is not fatal or you know even not necessarily even debilitating although it can be it's generally not judged to not be worth the risk and the invasiveness of that procedure so it's the the thyroid ultrasound and the antibody testing and then in my practice you know if there's someone that I just had a negative ultrasound and they found a few negative antibody tests but I really still suspect that they have that autoimmunity is a cause maybe have another autoimmune disease or maybe maybe they just have the signs and symptoms of autoimmunity then I will do a therapeutic trial of an immune balancing regulating treatment and see how they respond and if they respond really well to that and that's really all the evidence I need to you know to to help do like a an immune balancing regimen from a functional medicine perspective so that's that's the the baseline here to understand in terms of Hashimoto's because there's a lot of misunderstanding I think out there and both the conventional side and the alter sided about about how to diagnose it and what it means if you actually have it and Chris so you know the listeners talking about coming off medication but we're talking about Hashimoto's and sort of coming up and down and lab ratings that might not even be existent we're talking about treatments that you know sometimes we just use so the question I'm wondering is is there a point in which autoimmunity ever just stops or are we always a little bit autoimmune I guess what I'm trying to ask is is should people be thinking like oh I cured my you know should the goal be that I cured my autoimmunity or I reverse my autoimmunity or are we approaching a limit of infinity of what is actually possible inside the body well I can tell you the the conventional view and then I can we can we can speculate and look at some alternative views so the conventional view is that once antibody production starts to a tissue it doesn't stop and that's actually the reason for that is is that that's a what that's a that's a good thing mostly it's what I'm trying to say here the if you get exposed to a virus or a bacteria on a pathogen any kind of pathogen that we can produce antibodies to that's the way the immune system is designed to work that if you get exposed then to that pathogen twenty or thirty years even later you have these memory cells that remember and can start producing antibodies to that pathogen again even thirty four years later and that's that's the brilliance of our immune system so you only really have to be exposed once and then you're protected from that for a lifetime and and and that's when things are functioning well but that really clever system can backfire on us when what we're producing antibodies to is tissue in our body right because once that antibody production starts the immune system is designed to remember so that it will always continue to do that so that's so that's the conventional view and and in that way of looking at autoimmune disease is not curable it's only manageable what you can do is reduce the environmental triggers that provoke and exacerbate the the inflammatory response that destroys the tissue that we're producing antibodies to and that's why we talk so much about things like the autoimmune Paleo protocol and glutathione and things that promote T regulatory cell function etc other others have speculated more recently that things like intestinal permeability or a precondition for the development of autoimmunity and that it's possible in certain circumstances that healing the gut reducing that permeability for example for example would stop the process of autoimmunity and and essentially cure it and I don't really think we know enough about that yet to say whether that's possible what I can say is it probably depends on the definition of cure so let's think about something like celiac disease but if you remove gluten from the diet and do a number of other things and possibly other grains and dairy and cross-reactive proteins etc that person could become completely symptom free right so is that a cure it depends how you define it because generally if that person starts eating gluten again they're gonna get very sick and so in in the strict definition of a cure that's not really a cure because it cure would be getting them to the point where they can eat gluten it with impunity and not experience any symptoms at all so that it's not a cure but it's effectively managed to the point where they don't even have symptoms at all by making a relatively some relatively simple changes in their life maybe not easy but relatively simple so that's kind of the way I look at it is that you can you can these these conditions can often be managed to the point where the symptoms are either gone or not intrusive in in one's life but as far as that background autoimmune reaction I haven't yet seen a lot of evidence either clinically or in the research that that can completely be cured to the point where there's no change required so okay so this the second or the third thing we wanted to address third question was what causes two conversion problems from t4 to t3 so if you recall t4 is stuff is 94 percent of what the thyroid gland produces in terms of thyroid hormone is t4 and then that t4 has to get converted into t3 because t4 is not very active metabolically and t3 is the thyroid hormone that really activates two cellular receptors and does everything that thyroid hormone is supposed to do so the thyroid gland produces most of the t4 and then else we're not in the thyroid gland but elsewhere around the body that t4 gets converted into t3 which is the active form so what Rayven is saying is asking about what we often see is people who have either normal or low normal t4 and then they have low t3 and what that indicates actually is that the thyroid gland is maybe functioning okay but the conversion of t4 to t3 that's happening out all around the body is not working well and that's a really important thing to understand t4 to t3 conversion problems are not thyroid problems they're not problems with the thyroid gland there are problems that are caused elsewhere in the body that affect the the thyroid system they affect the cells ability to you know to receive t3 thyroid hormone and that manifests in in hypothyroid symptoms but they're not actually a problem with the thyroid gland and it's crucial to understand that because it completely informs how we address t4 to t3 conversion problems for example giving the patient a bunch more tea for medication is probably not a great idea in that situation because the t4 is not being converted in the t3 but that's the standard treatment for a lot of thyroid problems is just give centroid or levothyroxine which is a t4 based medication so what's going wrong in this situation it's usually three primary causes inflammation poor gut health and very low carb diets if the person is in that world so inflammation inflammatory cytokines can really mess with t4 t3 conversion in several different ways they well inflammation let me back up inflammation can suppress t4 to t3 conversion so it just inhibits that process but it also messes with thyroid function in other ways it reduces the pituitary output of TSH and it also reduces the cellular sensitivity to thyroid hormones so even if you have enough t3 floating around in your system your cells can't receive it and it doesn't activate the cellular receptors and and so the you end up with symptoms of hypothyroidism even if your labs are normal so that's inflammation poor gut health so 20% of the conversion of t4 to t3 actually happens in the gut and so if you have poor gut health disrupted gut microbiome SIBO parasites leaky gut etcetera then it's entirely possible that that t4 to t3 conversion it's supposed to happen and it got is not happening or not not happening well at least and of course got problems typically lead to inflammation so you get a little bit of a double whammy there with with when you have gut issues and Chris so with with 20% now obviously it's not like if you have a banged-up gut it's gonna be zero but we're talking about a range here of 0 to 20% so it's gonna have some fraction of that but let's say that the body between the body and inflammation we've lost 10% is 10 percent enough that we're gonna be feeling that on a daily basis I think it will depend on the person you know but let's say the more real-life scenario is probably let's say you lose ten percent of the conversion than the gut but you have inflammation because your gut is screwed up so that inflammation is also reducing t4 to t3 conversion outside of the gut so that's maybe another 10 20 percent I mean these numbers are just made up I have no idea I don't think there's ever been a study to show exactly that but and then let's assume that your cells are less sensitive to the effects of thyroid hormone that you do have because of this inflammation so even even though you maybe only have a 20% reduction of your t4 t3 conversion you're not as sensitive to the t3 that you do have so you get all of these combined these factors that combine to reduce your the effectiveness of your overall thyroid system and that's probably more how it happens in a real moral scenario and then maybe you're on a very low carb diet because you're trying to lose weight or you you know just been told that that's a good kind of default approach problem with that is insulin is required to convert t4 and t3 and we hear a lot of you know bad things about insulin and certainly insulin resistance is not good but insulin is a vital hormone that plays a lot of important roles and one of them is is this conversion of t4 to t3 and if you're on a really low carb like ketogenic diet over a long period of time you're bound to have very low insulin levels and in some people not everyone I've talked about this a lot and talked about it on a Jimmy Moore show we've had a lot of discussion about this I want to be clear that this doesn't happen to everybody but it's more likely that someone who's on a ketogenic or very low carb diet will have low levels of t3 so those are the three main issues inflammation poor gut health and very low carb diets that can cause t4 to t3 conversion problems and what that means from a clinical perspective is that just giving more t4 medication is not the answer and even giving t3 medication although it can help is not really the answer from a functional medicine perspective because that's that's kind of putting a bandaid on the problem and sometimes band-aids are necessary they help protect the wound and and help it to heal but you really want to address the underlying problem with functional medicine to get the best long-term result and if you need to use a band-aid for a period of time while you're doing that that's fine there's nothing wrong with that I do that in my practice but not at the expense of addressing the underlying issue okay so what's this happen exactly and you know another analogy we often use in functional medicine is the tree so like for an order for a tree to have healthy branches and and leaves you have to take care of the roots but sometimes you need to do a little bit of pruning on the branches in order for the tree to be healthy too and so it's not just that we are at the exclusion of all else focusing on the root cause but it's it's that we always want to do that at the very minimum and then on top of that we may also need to address the symptoms specifically just for someone to feel better and function in their lives okay so the the last piece we need to talk about is what's the significance of a TSH of zero or zero point zero something zero point zero seven I think it was for Raven and low t4 when you're taking the thyroid medication particularly thyroid medication that has t3 in it so typically a TSH of zero what this means is that the it either means you have hyperthyroidism if you're not taking thyroid medication but if you're taking thyroid medication it means your dose is too high because if you recall how the thyroid system works the pituitary is the gland and the brain is like the control tower that's constantly monitoring how the levels of all hormones in the in this case thyroid hormone and when thyroid hormone levels are high or higher than the two eteri thinks they should be it will reduce the output of thyroid stimulating hormone or TSH that's the signal that it sends to the thyroid gland and tell it how much thyroid hormone to produce so if thyroid hormone levels are high TSH will drop because the pituitary is basically saying that the thyroid hey we've got you know more than enough as it is so don't make any more on the other hand if thyroid hormone levels are low then you'll CTSA to go up because the pituitary at that point is shouting at the thyroid gland hey you know kick things up a little bit we've got low levels of hormone so when you see a level of zero that means the pituitary is like slamming on the brakes and saying no more thyroid hormone this is this is too much and that's a sign that your thyroid medication is too high typically so you want to speak with your doctor about modulating the dose of the medication so that your TSH range is back in that normal range of 0.5 2 to 2.5 that's that's the functional optimal range for TSH in terms of low t4 that's also typically a reflection that you're taking thyroid hormone particularly t3 because if you think about it again the way that the body protects itself from too much hormone is it would tell the thyroid to produce less thyroid hormone and then the thyroid itself would produce less thyroid hormone which is t4 so seeing this pattern is very typical when someone is on thyroid medication now I do want to say that if TSH is normal or like at the low end of the range like 0.5 s or something like that and t4 or free t4 is slightly low like maybe 0.8 for free t4 or maybe like 5 for total t4 that's not necessarily a problem that's that's just indicative that you're taking a syn you know supplemental t4 t3 combination or just t3 alone and it's not a problem what determines whether it's a problem is the TSH level so if the TSH is like at zero and t4 is low I would say that's a clear indicator that the medication dose is too high if the TSH is normal and the t4 is slightly low I would say that's probably not an issue and of course B this is you know we have to save us if before you make any changes to your medication make sure to speak to your doctor don't take this as medical advice I'm just sharing with you what the research says about these numbers and what this means if TSH is above two and a half it means your dose is too low so or you're not addressing other fundamental problems like the gut issue and some of the things that we talk the inflammation and some of the other things that we talked about that's probably a topic for a separate show but the lab range for TSH as I mentioned is usually is too broad it's usually 0.5 to 4.5 but more recent studies have shown that normal healthy functioning thyroid the TSH range is 0.5 to maybe 2.2 at most 2 point 5 but definitely not four point five what's that I can't even hear it my earplugs are so good that was my landline sorry I forgot to take it out so when did that start ringing can go back you basically saying that this is a topic for another show TSH is awesome I'll start I'll start there so this is a topic really for another show but I'll just briefly say that the TSH range that you see on a lab test that you get from LabCorp request or whatever is too broad it's usually 0.5 to 4.5 but more recent studies have found that the normal range for a healthy functioning thyroid is 0.5 to maybe 2 2.2 and at the maximum 2.5 but not four point five minutes that's too high okay so let's wrap this up and then we're probably going a little longer than normal today but the so let's we circle back now to Ravens main question which is and a lot of people's main question I hear this all the time is is it possible to get off thyroid medication and the answer after all everything that we just went through is it depends it's always the answer and it's true it depends of course I hope you can see this now on what's causing the problems so in Ravens case if she truly doesn't have Hashimoto's it's possible that fixing the gut and reducing inflammation if that if that's what's causing the low t4 to t3 conversion would be enough to resolve the problem and she wouldn't need to continue to take thyroid medication or maybe in another situation if we found out that even was iodine deficient and that was the real cause or selenium or zinc deficient I I'm gonna add this back to t4 to t3 conversion problems selenium deficiency and zinc deficiency can also cause problems with t4 to t3 conversion so you know if we if we find that she's deficient in selenium zinc we restore those nutrients the t4 and t3 conversion improves no more need for thyroid medication so you just opened up I don't that that'll just take us too far down the rabbit hole and we'll come back to that so so yeah I mean if the cause of the thyroid problem in the first place can be addressed then yes you can get off the thyroid medication but what if Raven does have Hashimoto's and what if she had it for 20 years before she developed hypothyroidism which is entirely possible and often common and what if over that period of time the immune attack against the thyroid gradually destroyed the thyroid tissue which is where the thyroid what where tyre and hormone gets produced in that case is probably not possible and not even desirable to get off of thyroid medication because thyroid hormone is so essential to every cell in the body that any potential downside of taking thyroid hormone replacement either like pharmaceutical approach synthetic like synthroid or levothyroxine and site amel or you know bioidentical porcine thyroid source medication like armor or nature thread or desiccated Pig thyroid that you can buy over-the-counter that would all be advisable over the long term in a person like that because they need the thyroid hormone to function well and their thyroid gland is compromised and as far as we know that doesn't that tissue doesn't grow back so in that situation and that person would not it wouldn't be possible for them to get off the iron medication I wouldn't even be a goal that they should be thinking about so it really depends on the situation as I hope you can see from today's show and I Raven I hope that answer your question I hope everybody else got something out of that as well was a lot of information in a short time but but hopefully that helps yeah cuz I think that was a great wrap up and I mean we didn't start the show with this because it would ended up being like a 5 hour show but you know the thyroid is are of a much larger axis called the HP ATG access so basically every clan that's part of the hormone structure and so if you're looking to get off your medication you really have to begin to look at every area of this access but you know I think I think we've given a raven a lot of things to work with here today yeah I hope so so thanks again everyone for this thing Steve good to have you back and we'll see you next week yeah thanks Kristen and in between shows Chris was always doing lots of research you know I think he does research so he's always spitting out new studies and new articles on Facebook / Chris presser and Chris presser as well hey everyone don't let Steve tell you I don't sleep you know how important sleep is 78 hours every night but maybe I just figured out a way to process research in my brain while I'm sleeping I play playing in my headphones you know like the brainwashing thing as I sleep and I wake up and I'm like wow yeah I was thinking osmosis like that Garfield cartoons racing from the book yeah all right try that – all right everyone see you next week you

5 comments

  1. Hi Doctor
    I take sinds 15 years Eutirox 125. The latest blood test showed a decreasing of the THS until 0,05. At the same time the T4 had a normal value, which was 1,22. My regulair doctor said, that he does not change the dosage, becaus the T4 is O.K. Listening to your video, If I had understood it well, in this case the dosage of the medication is to hi. Is it correct? What can you advice? Thank you very much. I am graitfull for your answer.

  2. Is it possible the Anti-bodies are elevated because of something else??https://drchristianson.com/epstein-barr-virus-the-hidden-cause-of-hashimotos/

  3. if only blood tests were cheap. in uk we need to ask for gp's approval for blood test. i suffer from underactive thyroid and cannot check for free my iodine, selenium, zinc, iron . i have a plant based diet. lots of veg and fruit.

  4. Emily – although a Paleo diet CAN be very low carb, it neither must be nor typically is.  Perhaps many paleo peoples ate lower carb, but not many probably ate very low carb….and at least not all the time.  Paleo is mostly just removing from the diet any "foods" that are not natural, things you would not have found in the diet either previous to 150 yrs ago, or previous to agricultural civilizations (approx 10,000 yrs ago).  Meaning, some people consider dairy to be paleo, some don't…among other distinctions.  For instance, fruit is paleo, and also higher carb.  However, eating only fruit exclusively is not really very paleo as you would not have found paleolithic peoples who subsisted entirely on fruit.  There is a wealth of info online and in books….Chris Kresser is an AMAZING resource, and his book is very helpful.  But Paleo is rarely distinguished as being very low carb.

  5. you speak about trouble caused by very low carb diet, but isn't that what you promote with the Paleo diet? CONFUSED

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