By: Emily Cleveland-Job, Naturopathic Doctor

Synthetic Thyroid

He was only 32 years of age, a New York Italian male with a thick New York accent. I first encountered M.G. (I am using his initials here) when I was practicing in the State of Oregon. The state of Oregon, like many states, fully recognizes Naturopathic Doctors as family providers.

Right away M.G. told me that he had gone to his family provider in New York because he hadn’t been feeling well for a few years and had been having some trouble with weight gain and fatigue.  The provider had run a thyroid lab test called TSH (thyroid stimulating hormone) and determined that M.G. had hypothyroidism. The provider then prescribed him a synthetic thyroid, levothyroxine, at the dose of 50mcg daily. Prescribing synthetic thyroid is the standard of care for mainstream medicine.

No More Martial Arts

Soon after starting the medication, M.G. told me he started suffering severe muscle weakness and fatigue.  Being in martial arts, this was devastating to him. He was too tired and too weak to practice or participate in tournaments. He felt he was losing his manhood.

M.G. contacted his New York provider about his new symptoms and the provider said they couldn’t be caused by the levothyroxine and that he should keep taking the medication. M.G. listened to his provider and continued the synthetic thyroid, levothyroxine, and GOT WORSE.

Maybe the New York Doctor is Not Right

M.G. was feeling terrible. He was weak, was tired all of the time and felt worse on the very medication his provider said was supposed to make him feel better. His New York Doctor ignored him when he tried to tell him he was feeling worse.

When M.G. called me, I listened to him and asked him to come to my office. We decided to run a number of tests so we could pinpoint exactly what was happening with M.G.’s thyroid. The TSH test is only one test. It unfortunately is the one most commonly used by mainstream medicine. The values have changed over the years but the results are constant. When the value is over the upper range, the standard of care is to prescribe the synthetic thyroid (like levothyroxine, synthroid, levoxyl). Mainstream medicine is not taught to test the active form of the thyroid, Free T3.

How to Do Comprehensive Testing for the Thyroid

I wanted to make sure what kind of hypothyroidism M.G. had so we ran a few thyroid antibody tests.  We also looked at his blood counts, a full metabolic panel, as well as a lipid panel.  First of all, his antibodies came back extremely elevated, typical of Hashimoto’s thyroiditis, an autoimmune-type of hypothyroidism.  Further, his lipid panel (cholesterol) came back and his total cholesterol was 250 (should be <200), his HDL (healthy cholesterol) was 29 (should be >40), LDL (lousy cholesterol) was 120 (should be below 100), and his triglycerides were 1352 (should be <150)!!!! These were terrible results and told me there was definitely something wrong with M.G.

The nurse in our clinic actually brought M.G.’s blood sample for me to see after he had spun it down in the centrifuge.  M.G.’s serum was milky white where normally it should be a clear, golden liquid. His blood serum was milky because of all those triglycerides (fat) floating around!

Sorry, Italian or Not, You Have to Change Your Diet

At this point, I asked M.G. if his previous provider had prescribed a statin for his cholesterol. I thought maybe his muscle weakness had been a side effect of this common cholesterol therapy. Statin drugs can lower testosterone, cause muscle aches and pains and weakness. They have also been show to increase the risk of diabetes. High triglycerides are a definite risk factor for diabetes as they generally mean the diet is not healthy (too much sugar or too many unhealthy grains or both). M.G. did have an unhealthy diet; however, he was not taking any statin drugs.

Wheat Free / Gluten Free. We began to come up with a treatment plan.  *It is my policy to always recommend a gluten-free diet to anyone who has Hashimoto’s.  M.G., an Italian-American, looked at me like I was nuts.  “Doc, I gotta have my pasta!”  I said you can live or not and get back to your beloved Martial Arts or not but only if you give up all wheat and gluten for at least 3 weeks. At that time, we will revisit your diet.

Natural Thyroid

*Next I recommended that we do a compounded, gradually released, T4/T3 combination for his thyroid.
I chose to use a bioidentical T4 and T3 (the one originally prescribed only contains the T4 and does not contain the active form T3). A compounding pharmacy makes this and can make it so it can be gradually released.  I like using gradually released thyroid as I feel this better mimics the way the thyroid would produce the hormone naturally.

*I also recommended that we start a niacin regimen to help with his very low HDL and his cholesterol in general. He was going to need to increase his fiber and greatly decrease his carbohydrate and sugar intake to improve his cholesterol profile.

At the end of that visit, M.G. told me he was so desperate, he would do whatever was needed, even if it involved no wheat or gluten.  I sent him on his way and said we’d check in after 6 weeks with a full thyroid panel, lipid panel, and liver function tests (to make sure he tolerated the niacin well).

WOW! What a Change

After 6 weeks, his thyroid was in normal range; he had lost about 15 lbs., had started exercising again, and was feeling great!  He came back in and said “Doc! You saved my life!”  His thyroid labs were almost optimal.  His cholesterol, LDL, and HDL were now in normal range, and his triglycerides had dropped to 320.  I asked how he was doing on the niacin and he confessed that he never ended up taking it!  I was shocked at how great his lipid panel looked and the only two changes he made were the thyroid medication and a gluten free diet.

M.G. admitted that it had been hard and he wasn’t 100% gluten free, but he felt so good, he would continue avoiding gluten when possible.

M.G. has since moved back East, but we maintain our provider/patient relationship because he won’t trust anyone else with his care.  I am very flattered by his faithfulness and thankful that the plan we came up with, as simple as it was, helped him so much.  He has given me permission a number of times to write about his case.

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M.G., a 32 year old male, called to have a free consultation with me back in 2009, while I was still practicing in Oregon. I could tell immediately that he was originally from New York because of his thick accent. M.G. told me that he is through and through a New York Italian. He described his situation as follows.  He had gone to his provider because he hadn’t been feeling well for a few years and had been having some trouble with weight gain and fatigue.  The provider had run a thyroid lab called TSH (thyroid stimulating hormone) and found that M.G. had hypothyroidism.  He was starting on levothyroxine 50mcg daily.

Soon after starting the medication, M.G. started suffering severe muscle weakness and fatigue.  Being in martial arts, this was devastating as he was no longer able to participate in the sport.  M.G. contacted his provider about his new symptoms and the provider said they couldn’t be caused by the levothyroxine and that he should keep taking the medication.  M.G. was very compliant and continued the medication, though he felt something was off.

I, too, wasn’t sure if or how the symptoms were related to the levothyroxine, but felt there can always be exceptions to the rule.  I had him come into the office and we decided to run a number of tests.  I wanted to make sure what kind of hypothyroidism he had so we ran a few thyroid antibody tests.  We also looked at his blood counts, a full metabolic panel, as well as a lipid panel.  First of all, his antibodies came back extremely elevated, typical of Hashimoto’s thyroiditis, an autoimmune-type of hypothyroidism.  As well his lipid panel came back and his total cholesterol was 250 (should be <200), his HDL was 29 (should be >40), LDL was 120 (should be below 100), and his triglycerides were 1352 (should be <150)!!!!  The nurse in our clinic actually brought M.G.’s blood sample for me to see after he had spun it down in the centrifuge.  M.G.’s serum was milky white where normally it should be a clear, golden liquid.  When we got the results back, we realized his serum was milky because of all those triglycerides floating around!

At this point, I asked M.G. if his previous provider had prescribed a statin for his lipids.  I thought maybe his muscle weakness had been a side effect of this common cholesterol therapy.  However, M.G. stated he had never been recommended a statin by any providers.

We began to come up with a treatment plan.  It is my policy to always recommend a gluten-free diet to anyone who has Hashimoto’s.  M.G., an Italian-American, looked at me like I was nuts.  “Doc, I gotta have my pasta!”  I apologized profusely and asked him to please give up all wheat and gluten for at least 3 weeks and then we’d talk.  Next I recommended that we do a compounded, gradually released, T4/T3 combination for his thyroid.  I chose to use a synthetic T4 and T3 as this is bio-identical and through a compounding pharmacy can be gradually released.  I like using gradually released thyroid, as I feel this better mimics the way the thyroid would produce hormone naturally.  I also recommended that we start a niacin regimen to help with his lipids.  He was going to need to increase his fiber and greatly decrease his carbohydrate and sugar intake to get his lipids down.

At the end of that visit, M.G. told me he was so desperate, he would do whatever was needed, even if it involved no wheat or gluten.  I sent him on his way and said we’d check in after 6 weeks with a full thyroid panel, lipid panel, and liver function tests (to make sure he tolerated the niacin well).

After 6 weeks, his thyroid was in normal range; he had lost about 15 lbs., had started exercising again, and was feeling great!  He came back in and said “Doc! You saved my life!”  His thyroid labs were almost optimal.  His cholesterol, LDL, and HDL were now in normal range, and his triglycerides had dropped to 320.  I asked how he was doing on the niacin and he confessed that he never ended up taking it!  I was shocked at how great his lipid panel looked and the only two changes he made were the thyroid medication and a gluten free diet.

M.G. admitted that it had been hard and he wasn’t 100% gluten free, but he felt so good, he would continue avoiding gluten when possible.

M.G. has since moved back East, but we maintain our provider/patient relationship because he won’t trust anyone else with his care.  I am very flattered by his faithfulness and thankful that the plan we came up with, as simple as it was, helped him so much.  He has given me permission a number of times to write about his case.