I was diagnosed with hypothyroidism ten years ago, after my sister was diagnosed and I went in to get my TSH checked. I’ve been on synthetic T4 (levothyroxine, aka Synthroid) for most of that time, except for a small period that I was off meds altogether. Chances are, your doctor will only tell you about one option, but I think treatment can be grouped into four choices:

1. synthetic T4
2. natural thyroid extract (Armour Thyroid)
3. low-dose naltrexone
4. nothing

Doctors will ask for a TSH test if you think you have hypothyroidism, or if for some other reason they suspect that you might be hypothyroid. TSH stands for “thyroid stimulating hormone”; it’s put out by the pituitary gland in response to the production of TRH by the hypothalamus. Patients with hypothyroidism and low free T3 and T4 levels will have high TSH levels, but I haven’t found any research directly linking T3 or T4 to TRH production. It seems to make sense, but there’s no knowledge there; just theory. For the most part the theory works. But not always.

And that’s really why I’m writing this post. Some people with hypothyroidism report that some symptoms improve when they start taking synthetic T4 (basically bypassing production from the thyroid), but that other symptoms persist. These people report much improved symptoms when they switch to a natural thyroid hormone replacement (ie Armour Thyroid), which contains not a synthetic T4 but a natural T4, as well as T3, and a bit of T2 and T1. T4 is the storage form of the thyroid hormone; T3 is the active form used by cells. (The number indicates the number of atoms of iodine in the molecule.)

Some people have trouble with T4-to-T3 conversion; some have adrenal fatigue; there’s a whole range of problems. Most doctors give you a TSH test, look at the number, then prescribe Synthroid and tell you any remaining symptoms are just because you’re a lazy fuck and should stop whining. Yeah, I haven’t been happy with my doctors, and many other hypothyroid patients haven’t either. Anyway, the most common cause of hypothyroidism is what’s called Hashimoto’s Thyroiditis; it’s an autoimmune disease, in which your own immune system attacks your thyroid, preventing the production of thyroid hormone. Research on molecular mimicry by Dr Loren Cordain suggests that this process is started when foreign proteins cross from the digestive system into the bloodstream; prevention is to not have a leaky gut, perhaps caused by grains, one reason why us paleo people avoid eating them. And one damn good reason why you should never feed grain to your kids.

The third treatment option is what’s called low dose naltrexone. I won’t write much on it here other than to say that the theory behind it’s effectiveness is to tell the immune system to calm the f down, which then allows the thyroid to do its own thing.

The fourth option isn’t really an option. That is, I don’t suggest it. I did feel great when I went off of my meds for a couple months, but I also changed my diet and started some serious exercise, too. If the molecular mimicry theory is correct, then once you’ve got Hashimoto’s, you’ve got memory B cells that know what the antigen looks like. What happens in molecular mimicry is that a protein gets from your gut into your bloodstream; the immune system recognizes the protein as foreign and produces antibodies. Hashimoto’s is when that foreign protein is a molecular mimic of thyroid gland cells. (People with different genetics or different proteins will get other autoimmune diseases, such as rheumatoid arthritis or multiple sclerosis.) To the immune system, the foreign protein and the thyroid look like the same protein; the immune system then attacks the thyroid. Reducing the presentation of foreign proteins to the immune system might help reduce symptoms, but it seems that there is no cure for Hashimoto’s; you’ve basically vaccinated yourself against your thyroid gland, and there’s no way to remove those memory B cells.

Eating iodine-rich foods or supplements might help; some recent talk in the blogosphere suggests that 8-50 milligram range iodine supplement is needed; Lugol’s and Iodoral were two suggestions in the comments over at Richard’s site.

My current T4 refills are up in another month. I plan on switching to Armour. Meanwhile, I take iodine, but crappy microgram amounts; I’ll try and find Lugol’s and do that for a month.