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Do you know if you’re taking the right amount of thyroid medicine? When it comes to Hashimoto thyroiditis weight loss, just because you’re taking more does not mean you’re getting better. Let’s dive into how we can get a dose working for you, and your body, so that you can learn how to lose weight with an underactive thyroid today.
Thyroid Function Test
Before we get started talking about dosage, we need to make sure that we have an overview of the different labs that you need to know about:
- Free T3
- Free T4
- Thyroglobulin Antibodies
- Thyroid Peroxidase Antibodies
- Reverse T3
Each are important, so it’s crucial that you have a good understanding of each. Thankfully I have talked about each of these tests before and you can find out more by spending a little bit of time on my site (1).
The Process of Testing
Good testing means getting a full panel done. This is going to include a TSH, fT3, fT4 and thyroid antibodies (for our conversation today). You are also going to want to make sure that you are preparing the body the best way before you get these tests done.
Key Insight: If you are going to have a full panel of tests done, it should be done in the morning and before you take your day’s thyroid tablet. This way, you are able to get the best and most meaningful results possible.
Understanding Your Scores
Let’s get a quick refresher on what your scores mean when you have a full panel of tests done. When you are trying to understand your TSH scores, you want to know the following things:
- When your TSH scores run higher, it means you are low in thyroid.
- When your TSH scores run lower, it means you are high in thyroid
When you want to understand your free T3 and free T4 scores, it is going to be a bit more direct. When you are low in thyroid, your scores will be lower – and vice versa!
The problems, or the wrinkles as I like to call them, begin when we start talking about ranges. As I have told you before, the TSH range is actually quite wide. Many who are in the “normal” range, but on the high side, can be hypothyroid. It actually confuses a lot of what we think of as “normal,” because it is actually not healthy.
At the same time, free thyroid hormones are just as tricky. They can fluctuate all of the time, and studies have shown this (2). Just because you are relatively healthy, does not always mean that your free thyroid scores are going to “add up” – so to speak!
It’s a tricky process, which means that understanding the appropriate dosage is going to be just as tricky. Let’s get rid of some of the confusion, and dive right into the concept of proper dosage for your thyroid today.
Too Little Or Too Much
There are so many people, those who fall in the “normal” TSH range, who are subsequently underdosed (3). When I think of the optimal place to fall on the range, it has to be low, but it is still within the range. When your TSH scores are between 1.5 – 4.5, and your free hormones are low to low-normal, you might still fall within the “normal” range but you risk being underdosed when you really need it.
The first real paradox I want to talk about, though, is that a higher dosage actually is not often doing more (or better) work. In fact, if you take too much your body actually becomes thyroid resistant.
Thyroid hormones are so powerful, and your body has so many different ways of controlling them – this way, they can perform so many tasks and keep your body humming.
- There is control from above, which includes the brain, and its signals telling the thyroid how to work and how to disperse more hormone.
- There’s also control from below. Your system has mechanisms that control how you eliminate thyroid hormones. These are used to regulate thyroid hormones after they have been released. These mechanisms involve your intestinal flora, liver function, kidneys, cortisol levels, cell membranes and mitochondrial permeability.
When a thyroid dose is higher than it should be, it takes two to three weeks for these mechanisms to start running faster. During this time, people often feel better or more energetic. They have received their higher dose, and they start saying to themselves “hey, I feel much better and I have more energy. That extra boost must have done something right.”
It might feel good in the moment, but it is definitely not good for your health in the long-term. Do not confuse immediate success with long-term success – they can be quite different concepts.
Key Insight: The problem with a boost in dosage is that it often does not last, and patients end up going back to feeling to normal – where “normal” involves fatigue, weight gain and other unpleasant symptoms.
The patient and the doctor often assume that raising the dose again will help, and it does for another brief period of time (4). The vicious cycle finds a way of repeating itself again and again, and because there are no short-term side effects it means that everything’s a-okay.
Unfortunately, what this approach does is leads to unsafe high thyroid blood levels. Higher doses of thyroid medication are not the answer, as this can lead to:
- Atrial fibrillation
- Grave’s eye disease
- Increase in Total Mortality
It is so important that we keep a close eye on the dose of our thyroid medication. What we do not want is to jump the gun and continuously boost our medication, forever seeking temporary relief from our symptoms. This simply is not a strategy for success, and can lead to really dangerous side-effects long-term.
In Conclusion: A higher and higher dose is not the way to go. In fact, while some doctors might argue for this strategy, all it can do is lead to high thyroid blood levels and dangerous side effects like strokes and dementia.
If the first paradox was all about making your body thyroid resistant, the second paradox is all about understanding the different ways that your blood levels might move when a dose is changed – and that they can be quite unexpected.
This point is so incredibly important. Understanding this will immediately give you an advantage over probably 99% of the physicians who prescribe thyroid medication.
When a TSH score first starts to get low, you might assume that the free T3 and free T4 will get high, but they often do not. The reason for this is that the body is trying to compensate. It lowers the TSH to prevent your thyroid from making any more hormone. At the same time, it is speeding the elimination of T3 and T4 which can cause their blood levels to be low-normal, low, or mid-range (rather than high).
If the TSH score is all the way to 0.01, and the dose keeps getting higher, eventually the free hormones do elevate – but this will not happen at first. It simply takes time.
Many thyroid experts encourage people to have their free hormones at the higher end of the range (5). Unfortunately this doesn’t happen without the TSH being too low, and that in itself does pose dangers to patients.
Studies done on people with healthy thyroid function find that their TSH runs in the low end of normal, but that their free hormones do not end up on the high side of normal. This works on the other end of the spectrum, too. When the TSH starts to elevate, the free hormones are not necessarily low.
If the TSH gets high enough, eventually the free hormones drop off when someone is extremely hypothyroid.
Good Labs, Bad Patient
What do you do if your labs are good, but you are still left feeling fatigued or dealing with unnecessary weight gain? Here are just a few of the things I think we might need to start considering:
- You may need different medication – I have seen so many instances where a dose reduction, followed by a medication change, has worked wonders for so many patients.
- You need to find your root cause – If you feel like you are only well when your TSH is low, then that is something you need to address. Boosting your dosage is not the answer, instead you need to find out more about the root cause of your problems. I would argue that it is important to find your root cause, so that you can minimize finding yourself in a state of risk.
You might also want to consider if:
- Your adrenals are not healthy (6)
- Your blood sugar is off
- You have high thyroid antibodies
Where Do You Start?
Start with the TSH! I know that this can be a controversial opinion, as many have said that we should simply ignore the TSH. I think this might be ignoring something very important. Your TSH scores can provide a really important launchpad for learning so much about the health of your thyroid. It does not have to end there, but it is a pretty good start.
The TSH is the first thing to adjust, because it represents the important work that our brain does when it comes to regulating the thyroid hormone. Your free hormone levels speak to greater problems down the road, not in emergency situations, so they are less important when it comes to starting an investigation into your health.
Once your TSH is optimal, the rest of your “local actors” find a way to sort themselves out. If there are still lingering issues, that is when we need to continue diving deeper and finding out more and more about root causes.
Key Insight: Address your symptoms, but know that they are often not the strongest indicators of what is actually going on in your body.
Ready To Learn More About Your Thyroid?
Your thyroid is so important. It controls powerful hormones which dictate so much of what goes on in your body. Do you know everything that there is to know about the thyroid? If you are concerned that you don’t, you need to take my thyroid quiz today. It will give you the information you need to benefit your body, and to live your best life. It’s always a good idea to keep your health in mind.
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Adrenal Reset Diet.
Dr. C’s gift for figuring out what really works has helped hundreds of thousands of people reverse thyroid disease, lose weight, and regain energy. Learn more about the surprising story that started his quest.