Category Archives for "Low Thyroid Causes"

Hidden Cause #14 Why You Still Have Low Thyroid Symptoms-Leaky Gut Causing Low T3

Hidden Cause #14 why you still have low thyroid symptoms even though you may be taking thyroid medication, and even though your lab tests are normal is…

  A Leaky Gut causing Low T3. 

Normally when I tell this T4/T3 story, I get to a certain part and then I kind of drop off…It’s because I usually don’t talk about the gut connection with T3.

So let me explain how the gut (gastrointestinal tract) affects thyroid hormones.

About 40% of the T4 that your thyroid gland makes gets converted into  Reverse T3 Reverse T3 is biologically inactive.  It doesn’t do anything.

About 20% of T4 gets converted into active T3.

Another 20% of T4 gets converted into T3 sulfate and T3 acetic acid.  This is what we’re interested in today.

Here’s why T3 Sulfate and T3 acetic acid are important:

In your GI tract T3 acetic acid and T3 sulfate can be acted upon by an enzyme called sulfatase.  When this happens, T3 acetic acid and T3 sulfate are converted back into T3.

Cool, huh?

So, out of the total available T3 that you have access to, a big chunk of that – 20% – is dependent on you having a healthy GI tract.

If you have:

  • dysbiosis (bacterial overgrowth, yeast or fungal overgrowth)
  • a leaky gut (intestinal hyperpermeability)
  • any kind of GI inflammation (from infection, food sensitivities etc)

…then you will have trouble making sulfatase. Without enough sulfatase you can’t convert T3 acetic acid and T3 sulfate into T3.

And you can end up with low thyroid symptoms, such as:

  • depression
  • hair loss
  • weight gain on a low calorie diet
  • requiring excessive amount of sleep
  • muscle pain and joint pain
  • brain fog
  • dry skin, dry hair
  • infertility
  • high cholesterol. 

You could suffer any or alll of these low thyroid symptoms  if you do not have a healthy gut.

What makes a healthy gut? 

Think of a healthy gut as a healthy garden.  A garden has lots of vegetables in it but not a lot of weeds…same for your GI tract. The good bacteria that live there, they are your defenses.  They are like your army.  They also help make some of your B vitamins.

And the health of that garden is what allows you to take T3 acetic acid and T3 sulfate and convert them into usable T3.

If you don’t have good GI health because of inflammation, leaky gut, parasitic infection, or food sensitivity…this will decrease sulfatase and your ability to convert T3 acetic acid and T3 sulfate into T3.

The other point I want to make about this is that there’s not a test you can currently do to look at T3 acetic acid and T3 sulfate.

And to be fair, if you had a drop off of 15% to 20% in your total available T3, that decrease might not be enough to change anything that you could measure on your blood work.

So having this problem is a sticky situation because your labs really do look “norma”,l but you don’t feel normal, and truthfully, your thyroid hormones aren’t normal.

How do you know if you have this problem with T3 acetic acid and T3 sulfate? 

If you have low thyroid symptoms and Gastrointestinal symptoms such as:

  • diarrhea
  • constipation
  • cramping
  • bloating 30 minutes or later after you eat
  • abdominal pain
  • stool is malformed
  • stool is greasy or oily

…then there is a probability that this gut-thyroid connection could be an issue for you–it at least needs to be checked out. It may be a hidden cause for your low thyroid symptoms.  It’s  “hidden” because your doctor has really got to dig for it.

How do you find this problem? 

You evaluate the GI tract.  You could certainly run tests for gluten sensitivity. The best current test is Cyrex Labs Array 3 ( I have no financial interest). But… you should save your money and probably just go gluten-free anyway because there’s a good chance you’ll test positive for some kind of gluten sensitivity.

You could also do a leaky gut test (the best one also being from Cyrex Labs–Array 2).

You could also look for yeast/fungal overgrowths, parasitic infections, or bacterial overgrowths.

Your doctor (or you) can pay for all that testing, but your doctor’s still has to know what to do with the results. Spending lots of money on tests is fine as long your doctor knows what to do if the tests are unclear or don’t make textbook sense.

But, you don’t treat a lab test.  What you’re supposed to do is treat the person. 

So, a good doctor should be able to take care of you without relying too heavily on a lab test.

Hidden Cause #14 is poor conversion of T4 into T3 because you have gut inflammation/ a leaky gut that’s causing a problem with the enzyme sulfatase…and that is decreasing your ability to convert T3 acetic acid and T3 sulfate back into usable T3.

It’s kind of a long pathway, I know– but it’s very real because a lot of women have it. And remember, you can have more than one problem at the same. You need to find a doctor who knows to look for it.

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© 2013 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #13 Why You STILL Have Low Thyroid Symptoms-Underconversion from Selenium Deficiency & High Cytokines

Hidden Cause #13 why you still have low thyroid symptoms even though you may be taking thyroid medication, and even though your lab tests look “normal” is ..

Underconversion of T4 into T3 caused by a deficiency of co-factors and high levels of cytokines. 

What is “conversion?”

About 97% of what the thyroid gland makes is T4, which is bascally inactive.  T4 must be converted into T3, which IS active.

How does conversion happen? 

An enzyme called 5′-deiodinase performs the “conversion.” Conversion takes place primarily in the liver. Certain important co-factors must be present in order for this enzyme to work correctly.  The #1 co-factor for this conversion is selenium. (You may have heard of selenium).

What are the symptoms of underconversion (low conversion)? 

Typical symptoms are your “classic” low thyroid symptoms:

  • depression
  • hair loss
  • weight gain
  • brain fog
  • dry skin
  • dry hair
  • high cholesterol (may not be from your diet. T3 is is the “co-factor” to convert cholesterol into your hormones).
  • constipation
  • infertility 

What does underconversion/low conversion look like on blood tests?

On lab tests (assuming the doctor is actually ordering these)…you may notice that the Reverse T3 is low.  That’s one little indicator of how much conversion is happening.

But you might also see:

  • Free T4 low
  • Free T3  low
  • Or you may see total T3 levels low

Or you may not see any abnormal lab results.  You may have only the low thyroid symptoms.
What could cause a deficiency in selenium ( or a “need” for selenium)? 

The #1 suspect is malabsorption.

Then you have to ask “Why would someone not be able to absorb selenium?”

First thing you have to consider is insuffficient stomach acid, called hypochlorhydria. Now, not too much stomach acid,  but not enough stomach acid.

If you don’t have enough stomach acid, you can’t demineralize your food.  You can’t suck the minerals out of it, and over time you’ll have depleted selenium levels.  Selenium wont’ be present in sufficient quanitiy to be  a co-factor for 5′-deiodinase to convert T4 into T3.

What would cause low stomach acid?

The first thing you look at is a Helicobacter Pylori bacterial infection.  The best test to check for this, in my opinion,  is a Urea Breath Test.  Hopefully, the doctor you’re working with will know about this issue and also know how to help you eradicate it, if you’ve got it.

Increased levels of cytokines is the second factor that causes  low conversion of T4 into T3, and low thyroid symptoms. 

Cytokines are immune system messengers.  They are part of inflammatory process.

So, if you have gastrointestinal inflammation or arthritic inflammation in a joint…

…or if you have any autoimmune disease like Hashimoto’s, rheumatoid arthritis or multiple sclerosis…you will have a high level of circulating cytokines.

Cytokines block conversion of T4 into T3 by slowing down enzyme 5′-deiodinase enzyme.

This next part is critical for you to understand:

You can have two problems at the same time.

For example, a person can have Hashimoto’s that’s destroying their thyroid gland from the inside out…AND…simultaneously have high levels of cytokines that are blocking the conversion of T4 to T3. 

You can have two problems at once.  There’s no rule that says you can only have Hashimoto’s.  You can also have side effects of Hashimoto’s.

Or the inflammation from another problem such as rheumatoid arthritis, or gluten sensitivity or a leaky gut can be causing the cytokines to be high and slowing down conversion.  A good doctor has to do a inflammation scavenger hunt to track down the possible source of inflammation.

Here’s the take-away:

If you have any of the following, your doctor should be suspecting a conversion problem:

  • low thyroid symptoms
  • low reverse T3 on blood test
  • low T3 or low free T3
  • You were prescribed Cytomel® because you didn’t get better on Synthroid® or levothyroxine. Synthroid® and levo are T4 and must be converted into T3. Taking Cytomel® bypasses the need for conversion…but…does NOT address the underlying problem that cause the converstion problem in the first place.

Underconversion/low conversion can be caused by a selenium deficiency, which makes us look at H. pylori and gut malabsorption….or underconversion can be caused by cytokines blocking the activity of 5′-deiodinase.

Who has high cytokines?  Persons with inflammatory conditions.

What are inflammatory conditions?  Hashimoto’s, rheumatoid arthritis, multiple sclerosis, psoriasis, persons with food sensitivitites.

You’ve got to put on your detective badge and your thinking cap and start looking for these things.

So if you’re still having low thyroid symptoms, this is something that should be considered, so you need to find someone who knows how to look for them and knows what to do if they find them.

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© 2013 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #12 Why You STILL Have Low Thyroid Symptoms-TPO co-factor deficiency

Dr. David Clark, DC- Center for Low Thyroid Solutions Raleigh-Durham-Chapel Hill, NC – explains how deficiency of Thyroid Peroxidase co-factors can cause low thyroid symptoms.

Hidden Cause #12 why you still have low thyroid symptoms even though you may be taking thyroid medication and even though your lab numbers may look normal is:

A deficiency of co-factors causing decreased activity of thyroid peroxidase (TPO) 

Thyroid peroxidase is the enzyme in your thyroid gland you uses to make T4 and T3.

So, if you don’t have enough activity of TPO, then eventually your aren’t going to make enough T4 and T3….and you’re going to have low thyroid symptoms.

Low thyroid symptoms include:

  • hair loss on the top of the head or the eyebrows
  • depression
  • brain fog
  • constipation
  • high cholesterol
  • joint pain
  • needing excessive sleep in order to function

Thyroid Peroxidase is frequently a cause for low thyroid symptoms because it is attacked in a condition called Hashimoto’s, an autoimmune condition. Hashimoto’s is the MOST COMMON CAUSE of Hypothyroidism.

But we’re not talking about Hashimoto’s today.  We’re talking about a situation that’s a little less common than Hashimoto’s.  The situation today is a deficiency of co-factors.

Co-factors are the vitamins, minerals and hormones that have to be present in the chemical mix in order for TPO to work correctly– and work quickly enough– to manufacture normal amounts of T4 and T3.

What are these important co-factors for normal Thyroid Peroxidase activity?

Let’s start with the minerals .  They include

  • zinc
  • copper
  • magnesium
  • selenium.

Then you have the B vitamins:

  • niacin
  • riboflavin
  • pyridoxine.

What I want you to understand is what groups of people would be at risk for having a deficiency in these co-factors.

Anytime you have a deficiency in minerals, the first 2 things to consider are

  1. poor stomach acid (hypochlorhydria)
  2. poor absorption in the intestines.

What could cause low stomach acid?

A common cause is a stomach infection with Helicobacter Pylori.Your doctor needs to screen your for an H. Pylori bacterial infection. H. Pylori loves to cause decreased stomach acid. I don’t really have time to go beyond that statement except to say that low stomach acid makes it VERY difficult to extract the mineral out of your food.

What could cause the malabsorption?

The most common culprit is gluten sensitivity (I”m talking about celiac and non-celiac gluten sensitivity).  I’ve got plenty of videos on that topic,  so make sure you are being CORRECTLY evaluted for gluten sensitivity — not just for “celiac disease.”

As for a deficiency in the B Vitamins, the first 2 things on the radar are:

  1. Methyl donor deficiency
  2. Reactive hypoglycemia (low blood sugar)

Methyl donors are the B vitamins.

Who’s at risk for low levels of methyl donors? 

  • Women taking birth control pills
  • People that use antacids,
  • People that have H. pylori infections,

These are all people that can have methyl donor problems.

Ultimately,  there’s not enough of methyl donors in the chemical mix to help Thyroid Peroxidase function normally…leading to decreased levels of T4 and T3…causing low thyroid symtpoms.

Reactive Hypoglycemics are on the list because they have a very difficult time holding on to their B vitamins–they lose B Vitamins.  Reactive Hypoglycemics are people that get shaky, lightheaded and irritable in between meals.  They can have a hard time staying asleep at night.  They  “crash” between like 2:00 pm and 5:00 PM.

If you have any of  those symptoms of low blood sugar…

…or you haven’t been checked for H. Pylori, hypochlorhyrdria, gluten sensitivity..

…Then this could be a hidden reason why YOU still have low thyroid symptoms.

Hidden Cause #12 is a deficiency in co-factors, vitamins and minerals, leading to decreased activity of thyroid peroxidase.

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© 2013 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.


Hidden Cause #11 Why You STILL Have Low Thyroid Symptoms – Low Progesterone

Dr. David Clark, DC- Center for Low Thyroid Solutions Raleigh-Durham-Chapel Hill, NC – explains how low levels of progesterone can cause low thyroid symptoms.

Hidden Cause #11 why you still have low thyroid symptom–even though you’re taking medication and even though your lab tests are “normal”– is:

A progesterone deficiency causing depression of the enzyme thyroid peroxidase (TPO).

Thyroid Peroxidase is an enzyme in your thyroid gland; and it’s one of the enzymes you use to manufacture T4 and T3.  So, if you don’t have good activity of this enzyme, then over time you’re just not going make enough T4 and T3. At some point, you’ll start suffering low thyroid symptoms such as:

  • Fatigue
  • Weight gain
  • Hair loss on the scalp or eyebrow
  • High Cholesterol
  • Infertility
  • Brain Fog
  • Depression
  • Constipation
  • Joint and muscle pain

How does progesterone play into this scenario? Well, normally, progesterone up-regulates TPO function.

Here’s what normally happens ( a bit of physiology, here):

In the second half of the menstrual cycle, when she ovulates, there’s s surge of progesterone. 

  • This surge of progesterone causes an uptick in the activity of TPO so that you make more T4 and T3.
  • This is why a woman has an increase in her body temperature when she ovulates because there’s a surge of progesterone.
  • That progesterone affects TPO in the thyroid gland, and that ultimately increases her metabolic rate and the temperature increases.

What happens when you don’t have enough progesterone? 

Well, when you don’t have enough progesterone, it’s pretty simple…TPO activity goes down and therefore, the amount of T4 and T3 you make goes down.

Here’s the key thing I want you to know about all this:

When a woman doesn’t have enough progesterone, she can have symptoms related to that progesterone deficiency (I’ll explain them in a second)–BUT, the progesterone deficiency may never cause the thyroid lab numbers to look “abnormal.”

This is why a lot of times a women will go to her doctor and be suffeirng low thyroid symptoms such as depression, hair loss, weight gain, high cholesterol, infertility, constipation, brain fog…

The doctor will run some kind of thyroid blood tests (usually woefully insufficient such as only a TSH and T4).  The doctor says, “Looks pretty normal to me.”  And if you have Low progesterone as your hidden cause for your low thyroid symptoms…there’s not much the tests could pick up on lab work. Why?

Because when a woman is not making sufficient progesterone for her needs, it may not necessarily be reflected in an abnormal T4 or T3 or TSH that’s below or above the lab range on blood work.

That’s why low progesterone is definitely a hidden cause because the doctor that you’re working with has to be able to recognize that you’ve got progesterone symptoms AND low thyroid symptoms.

What are the typical low progesterone symptoms? 

Many of these have to do with the menstrual cycle and getting pregnant so here they go:

  • irregular menstrual cycles and periods
  • menstrual cramping.  water retention before your period begins.
  • heavy menstrual bleeding
  • migraines in the second half of the menstrual cycle
  • early miscarriage
  • infertility
  • depression.
  • breast tenderness

If you have three or four of these symptoms…AND… and you’ve also got low thyroid symptoms, then low progesterone affeccting thyroid peroxidase in your thyroid gland could be a HUGE factor for you.

What do you do about this progesterone-thyroid problem? 

The most common cause that I see for low progesterone is a depressed level of luteinizing hormone (LH) in the brain caused by a stress response or a blood sugar problem.

If you want to boil it down, you can have low thyroid symptoms and low progesterone symptoms that are ultimately being caused by unstable blood sugar levels.  Blood sugar levels should be very stead…NOT up and down…peaks and valleys.

That’s a little bit beyond what we want to talk about today, but here’s the takeaway:

Whomever you’re working with…an MD, DC, ND, LAc…whomever… that person needs to be able to recognize if you’ve got low progesterone symptoms AND low thyroid symptoms.

What makes this more complex and difficult for many doctors is the fact that some of these symptoms overlap.

  • Low thyroid hormones (hypothyroidism) is a known cause of Infertility, miscarriage and depression. 
  • Low Progesterone is a known cause of Infertility, miscarriage and depression.

Your doctor must able to ask the right questions…do the right detective work and determine if Low Progestorone is a hidden factor your symptoms.

What do you about low progesterone? What’s the next step?

I’m not a big fan of people taking hormones unless, of course, they absolutely need them.  And I’ve got to tell you that most women that I’ve seen they didn’t need to actually take progesterone in a prescription,  nor progesterone in a supplement.  What they needed to do was work on fixing their blood sugar—and that’s a whole other topic for another day.

If you have progesterone deficiency…or just low, non-optimal levels of progesterone causing a down-regulation of thyroid peroxidase (TPO)…this can cause low levels of thyroid hormones.

So you need to find someone that understands this relationship and knows how to look for both low progesterone AND low thyroid at the same time.

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© 2013 David Clark. All Rights Reserved.Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.


Hidden Cause #10 Why You STILL Have Low Thyroid Symptoms – Antibodies to Your Own T4 & T3

Hidden Cause #10 why you STILL have low thyroid symptoms even you’re labs are “normal,” and even though you’re taking medication is:

An Autoimmune attack on your own T4 and T3 thyroid hormones. 

Now, this situation happens very commonly in people that already have some type of autoimmune condition (like Multiple Sclerosis, Celiac Disease, Rheumatoid Arthritis) and specifically it happens frequently in people that have Hashimoto’s.

So let’s give a little background…

Hashimoto’s is by far the most common cause of low thyroid or hypothyroidism—by far.  It’s an autoimmune condition.

Ironically, a lot of people will get tested for Hashimoto’s—and the test will show positive for Hashimoto’s, but…crazily…

Doctors don’t really do anything about the autoimmune problem other than give you replacement hormones like Synthroid®, Armour® or Cytomel®.

And to be fair, the replacement hormones will help some—but typically what happens over time is you end up feeling the exact same way you did before you were taking the thyroid hormones.

You have

  • constipation
  • depression
  • fatigue
  • hair loss
  • brain fog
  • nfertility symptoms
  • joint pain & muscle pain
  • sleep problems

Those symptoms are STILL with you even though you’re taking the medication the way you’re supposed to. How you react when you take the medication can be a clear sign and indication that you’ve got an attack on T4 and T3.

So here’s what I mean…

So let’s say you have those low thyroid symptoms.  You go to your doctor.  You get diagnosed as hypothyroid—but they don’t test for the Hashimoto’s antibodies–and they give you Synthroid®.

You take Synthroid®  but it doesn’t really do anything for your symptoms. So you read some article on the Internet about “bio-identical” thyroid hormones being superior to synthetic.  The internet information says Nature-Throid® or Armour® is the way to get releif.  You think:

“That sounds logical. Bio-identical is better because it’s natural.  I’m going to try it.”

When you take the Bio-identical thyroid hormones…suddenly you have a huge flare-up of symptoms,  a bad reaction to this bio-identical thyroid hormone that’s supposed to be better than synthetic.

What the heck is going on?

The first thing that’s probably happening, especially if you’re suffering swelling or headaches, pain, is you are attacking your own thyroid hormones.

Armour® and Nature-Throid® are bio-identical, meaning they look a lot like your own T4 and T3 hormones. If you’re already attacking the T4 and T3 that you make — and then you start to take some hormones that looks just like it–it’s just like throwing kerosene on a burning fire.  That’s why you get this sudden flare-up and feel worse.

Why would you be attacking your own T4 and T3? 

It’s usually the result of a progression of autoimmunity.  First, you’ve attacked the inside of your own thyroid gland–and you’re attacking thyroid peroxidase and/or thyroglobulin inside the thyroid gland.

Now, once that happens, the normal tolerance to yourself is broken. It’s gone.  Now your immune system can attack any other tissue, gland or hormone.

And it’s easier and quicker for your immune system to attack what’s in close proximity to the thyroid peroxidase and the thyroid globulin– the T4 and T3 hormones you’re making inside your gland.

This happens to a lot of people that develop undiagnosed Hashimoto’s.  No doctor diagnoses them with Hashimoto’s, and they don’t really find out they’ve got Hashimoto’s (or autoimmunity at all) until… they switch from a synthetic medication to a bio-identical.  That’s one scenario.

Here’s a second scenario that I really hope doesn’t happen to you.

A woman has these low thyroid symptoms.  She’ll get diagnosed hypothyroid.  They don’t test for Hashimoto’s, and she’ll be taking Synthroid or Levothyroxine for awhile.

And then she just decides that she wants to try something  else and see if it works better. Keep in mind.she actually feels “olay” on the synthetic thyroid hormones, but  she wants to see what might work better.

She consults that information wonder the Internet and reads something about Armour® and Nature-Throid® being superior. So she switches from synthetic to bio-identical and suffers this huge flare-up, bad reactiion.

The reason I’m bringing that up is if you’ve already got a medication that’s working for you…you’re feeling really good or, at least not bad, on synthetic medication…don’t switch.

Because if you switch, there’s a 50/50 chance you’re going to  have a really bad reaction.

If you do have a bad reaction to this bio-identical, that’s a sure sign that you’ve got autoimmunity and that you’re attacking your own T4 and T3. And, that before the T4 and T3 attack happened, you were attacking your own Thyroid Peroxidase and Thyroglobulin.

This is a hidden cause because most doctors have no idea what’s going on if you have a bad reaction to Armour® ,or a bad reaction to the Nature-Throid®.  I don’t care if they’re a DC, MD,  ND, whatever.  It confuses them.  They don’t understand why that’s happening.  If you’re having a reaction to that, it’s probably because you just threw some gasoline on the fire.

It’s the same thing as if you were to take iodine if you had Hashimoto’s.  Why is that?  Because iodine stimulates the production of TPO, which is what you’re attacking in Hashimoto’s. So you’re just giving your immune system more things to attack.

I think Quest now offers a T4 and T3 antibody test, but I’ve got to tell you there’s really no point in running that because the ranges are so ridiculously wide that I’ve seen that you’re probably not gonna show up positive for it anyway.

if you have a bad reaction to Armour® or a bad reaction to Nature-Throid® or another bio-identical, you probably have an autoimmune attack on your own T4 and T3 thyroid hormones…and you probably have Hashimoto’s as well.

You need to find a doctor that understands what to do with that Hashimoto’s and autoimmune problem because you are probably going to nned to switch back to synthetic. However — switching is not going to address the autoimmune problem.  That autoimmune fire is still burning, so you’ve got to find somebody that can help you deal with it.

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© 2013 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #9 Why You STILL Have Low Thyroid Symptoms – TSH Receptor Antibodies

Hidden Cause #9 Why you still have low thyroid symptoms is you have anti-TSH receptor antibodies.

That was a mouthful.  Let me say it again.

Hidden Cause #9 why you still have low thyroid symptoms even though your labs are “normal” and even though you take medication…is you have antibodies against the receptors for thyroid-stimulating hormone.

Now, this is semi-technical but I’m going to explain it to you this way:

Normally the pituitary gland sends a signal to your thyroid gland called TSH (Thyroid Stimulating Hormone). The TSH then tells the thyroid gland to make T4 and T3.

Hidden Cause #9 is an autoimmune situation that affects TSH.  The more common autoimmune cause of low thyroid symptoms is, of course, Hashimoto’s, which we’ve talked about.  But you can make antibodies to the little receptors for TSH.

This antibody is often called a thyroid-simulating immunoglobulin.  Typically, people that have antibodies against this TSH receptor are thought of as having Graves’ disease.

Graves’ disease is a hyperthyroid condition. It’s completely different than low thyroid.  So why am I saying this is a hidden cause for low thyroid symptoms?  Because there’s no rule about what these antibodies are going to do to that TSH receptor.

In Graves’ disease, they attach onto the receptor and they stimulate more  TSH and more thyroid hormones causing hyperthyroidism.  But there’s no rule that they’re going to do that every time.

TSH receptor antibodies also show up in people that have Hashimoto’s. 

TSH receptor antibodies can bind to TSH receptor and block it…Meaning it’s like you’re not getting any TSH.  And if you’re not getting any TSH, you’re not going to make any T4 and T3 and you’re going to become hypothyroid.

What kind of symptoms would you have?  You would have the classical hypothyroid symptoms:

  • constipation
  • depression
  • hair loss
  • fatigue
  • brain fog
  • high cholesterol
  • infertility
  • joint pain

Those are all things that you could have if you had TSH receptor antibodies.

Very few doctors check for these antibodies in someone that has LOW thyroid symptoms.  If you ask endocrinologists, GPs, naturopaths, acupuncturists, or even a doctor who understand functional medicine….

…and you ask them “What kind of symptoms would make you want to run TSH receptor antibodies?”  They would not say low thyroid.  What they would say are symptoms like increased heart rate, racing heart, racing pulse, racing thoughts, feeling shaky.  Those are all Graves’ disease symptoms.

Now here’s where it gets really confusing…

A person with Hashimoto’s can swing back and forth between low thyroid symptoms and periodic, temporary hyperthyroid symptoms.

The reason that swing is happening in Hashimoto’s  is because you get a flair up and the immune system attack that’s going on inside your thyroid gland, and it explodes a little segment of your thyroid gland…and dumps active free-state hormones into your blood.

Then you get hyperthyroid symptoms.

TSH receptor antibodies are typically thought of as something that you only check for in Graves’ disease.  And this is why it’s a hidden cause.

Follow what I’m saying….

You could have negative TPO antibodies.  You could have negative TGB antibodies.  But you could have positive TSH receptor antibodies and still be a Hashimoto’s case— And still be low thyroid.

I would be very surprised if you found a doctor in any field who would run that test and interpret it that way.  But that’s just the fact.  That’s what the literature shows.

How common are TSH receptor antibodies in Hashimoto’s?  Not very common but that’s also why it could be hidden.

If you look like you have Hashimoto’s.

If you act like you’ve got Hashimoto’s.

If people think you’ve got Hashimoto’s but they won’t do anything for you because they can’t prove you’ve got Hashimoto’s….then you might need this TSI or TSH receptor antibody test.

If the TSI or TSH Receptor antibodies are positive– and you’re hypothyroid, then you may have Hashimoto’s.  That’s when you have to take quick action.

Because now you’ve got an autoimmune condition.  And there a tone of things that can be done for that.  There’s things you need to avoid like the plague.  You must find someone that can help guide you through that like a detective.  Because there’s a lot of mistakes you can make along the way.

Trust me.  I see people in here every day that make mistakes like taking iodine, taking tyrosine.  These are mistakes until you find out what’s going on with you.

Hidden Cause #9 is TSH receptor antibodies, also called thyroid-stimulating immunoglobulins.  These antibodies can bind or block the receptor and cause you to have hypothyroid symptoms.

15% of Hashimoto’s patients test negative for TPO and TGB.  But some of these same people test positive for TSH receptor antibodies.  The moral of the story is get tested.  And then find someone that knows what to do to help you.

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© 2012 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.


Low Thyroid and Iodine Is A BAD Idea

I’m going explain why iodine supplementation is still a bad idea if you have low thyroid symptoms.

Earlier this year a new study was released about iodine supplementation  in Denmark.  Many years ago,  Denmark began fortifying their salt with iodine.

After a few years of salt iodination, the government assessed the results and were unhappy. They passed a rule to increase the amount of iodine put in the salt–a mandatory increase in iodine.

Well, some sharp researchers though..

“Let’s see if there’s a relationship between iodine and antibody production against the thyroid.”

To put it another way:

Does iodine cause Hashimoto’s Thyroiditis?

So let me back up and explain that.

For years, well-established, credible scientific data have shown that when you give people supplemental iodine —and this may be in a frankly iodine deficient area—you cause an autoimmune attack against the thyroid.

TPO antibodies and thyroglobulin antibodies are how you determine if there is an autoimmune attack on the thyroid gland.

The researchers from Denmark ran these exact tests in their quest to determine if iodine caused an autoimmune attack on the thyroid gland.

Here’s the citation so you so you can take a look at it.

Clinical Endocrinology (2011) 75, 120–126

(You would be shocked at the hate mail I get when I talk about iodine and it’s possible negative effects. It’s clear by their comments that they are either not actually reading, or they simply dont’ understand my point.)

This is my point about iodine, low thyroid symptoms and Hashimoto’s…

if you have low thyroid symptoms, you need to find out if you have Hashimoto’s or not. Because if you have Hashimoto’s, taking iodine is like taking toxic waste.

Iodine will make you worse.

Let me tell you a quick real life story about iodine…

Recently I had a patient, Kim.  She’s 36 years old and she had been taking iodine for seven years – for seven years—because some well-meaning but totally wrong alternative practitioner told her to take iodine for her low thyroid symptoms.

Quick Review of Low Thyroid Symptoms

  • gain weight easily, even if you exercise and eat “right” (low calorie)
  • hair loss, hair thinning on the scalp, eyebrows
  • dry, flaky skin
  • depression
  • brain fog, slow mental response
  • constipation
  • high cholesterol
  • infertility
  • sleep problems – can’t get enough sleep; sleep is not restorative

Turns out, that in all these years of suffering low thyroid symptoms…and after all these years of seeing doctor after doctor… Kim had never been tested for Hashimoto’s. 

For seven years Kim has felt bad.  In the last year and a half she’s got worse and worse.  Her hair’s been falling out, she’s gaining weight.

And all I did was say, “You know what?  Why don’t we just find out for sure if you’ve got Hashimoto’s?  Let’s find out if you’ve got these antibodies.”

Sure as heck, she’s got them.  It explains why she feels so bad.


Iodine is a huge risk factor for Hashimoto’s. 

In Denmark, where larger amounts of iodine have been put in the salt by law, the researchers  discoverd a shocking increase in elevated thyroid antibodies in the youngest age group of women – 18 to 45.

Denmark passed a law that’s given a huge part of their population Hashimoto’s Autoimmune Hypothyroidism.

This might sound strange, but…

Hashimoto’s is actually the least of your worries. Why?

Because once you have one tissue under attack from your immune system–pay close attention—your entire body is now on the menu. 

You can now attack your cartilage and develop rheumatoid arthritis…

…Or attack myelin and develop multiple sclerosis symptoms.

…Or attack your ovaries and develop infertility and various other polyglandular endocrine symptoms.

This is the new, real information about iodine and Hashimoto’s.

But I will probably still get flooded with hate mail or have people threatening to kill me and calling me a “murderer” because they don’t like what the research shows.  This is the truth, folks.

If you’ve got lot thyroid symptoms such as hair loss, weight gain, constipation…

If you’re taking thyroid medication like Synthroid®, Armour®, Naturethroid®, Levoxyl® or Cytomel® — and you STILL feel bad…

Then, you’ve got to find somebody to do these simple, non-exotic tests for TPO antibodies and thyroglobulin antibodies.

But here’s the catch…

If the results show you do have those elevate antibodies…you have a Hashimoto’s autoimmune attack on your thyroid….

Taking replacement thyroid hormones is only one tiny piece of the solution.

You need to find someone that understands the autoimmune situation. Someone who can help you get your immune system back into balance and slow down the autoimmune process (this can be done).

So to go back where I was at the beginning….low thyroid and iodine is a bad idea.

Yes, iodine is necessary to make thyroid hormones.  But, scientific data AND practical experience have proven again and again that iodine is dangerous.

Until you know whether you’ve got an autoimmune situation, I suggest you do NOT take iodine.

If someone is  telling you to take iodine for low thyroid symptoms (no matter who they are), it’s time they read a recent article with recent information.

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© 2011 Dr David Clark, DC


Just Diagnosed Hypothyroid? You Must Do This Next

If you’ve just been diagnosed with hypothyroidism by your doctor, here’s what you have to do next.

You have to go back to your doctor and demand that he/she run two tests –

  1. TPO antibodies (thyroid peroxidase antibodies)
  2. TGB antibodies (thyroglobulin antibodies)

Why should you yell and scream until your doctor orders these two tests?

Because the most common cause of low thyroid in America is a disease called Hashimoto’s.  It’s an autoimmune condition that can devastate your entire body –not just your thyroid gland.

Elevated TPO antibodies or elevated TGB antibodies indicate that your immune system is targeting and attacking your thyroid gland. Only ONE of the two antibodies needs to be positive to indicate Hashimoto’s.

Low thyroid symptoms are bad enough:

  • hair loss, hair thinning
  • constipation
  • sleep problems – feeling you could sleep 8 hours all over again
  • dry, flaky skin
  • depression
  • brain fog – feeling like your mental responses are slow
  • infertility
  • weight gain -even if you exercise and eat “right”

But, Hashimoto’s can lead to breakdown in the cerebellum, cartilage, nerves, pancreas or stomach.

Most GPs, family practitioners–even endocrinologists–don’t test for Hashimoto’s.  The only reason they ever seem to test for it is to shut up an insistent patient.

Hashimoto’s is an autoimmune condition in which your immune system targets your thyroid gland and literally eats it up – chews it up.  You lose pieces of your thyroid gland and you never get them back.

End results is, you can’t make thyroid hormones and you get low thyroid symptoms like depression, thinning hair, dry skin, constipation, brain fog, infertility, high cholesterol, okay?

If you have just got diagnosed with low thyroid, the next thing your must find out – whether your doctor thinks you should or not – is whether or not you have Hashimoto’s.

Hashimoto’s is a whole other ball game.

Sadly, your medical doctor is probably not going be able to help you with the autoimmune process. They really only have one way to work with any thyroid problem: thyroid  hormone replacement.

POINT: Almost all Hashimoto’s patients are going to require some replacement at some point because they are losing pieces of their thyroid gland.

Problem is —There’s at least 24 different ways that your thyroid hormones can go wrong.  Only one of the 24 responds well to thyroid hormone replacement.  That’s why there’s millions of women who still feel lousy even though their lab tests are normal…Even though they’re taking the thyroid medication like they’re supposed to.

They still feel bad because most of them have Hashimoto’s. And the autoimmune part of the problem has been ignored.

I want you to have hope that you can feel better.  If you’ve been newly diagnosed hypothyroid, you need take action.

You’ve got to stand up for yourself and demand those tests: TPO Antibodies and TGB Antibodies.

What to do when the TPO antibodies and TGB antibodies test results come back….

If TPO & TGB antibodies are negative, two things:

  1. 15% of Hashimoto’s patiens are seronegative–meaning they never test positive for the antibodies but have Hashimoto’s anyway. Keep reading below.
  2. There are 23 other reasons why you could have low thyroid symptoms. Find a doctor to investigate these 23 other causes.

If TPO & TGB antibodies are positive…

You must find a doctor that understands how to approach Hashimoto’s from a functional perspective…someone who understands that there’s even more testing that has to be done.

See, there are triggers for Hashimoto’s…factors that perpetuate Hashimoto’s–keep the fire burning—and we have to investigate and uncover them.

You have to put together the whole jigsaw puzzle and figure out…

  • Why your immune system is out of balance.
  • What’s fueling the fire in your body?

Hashimoto’s low thyroid reality check…

Once you have an autoimmune condition (like Hashimoto’s), chances are good that you will end up with another autoimmune condition.

Here’s what I mean by that…

Normally you’re not supposed to attack and kill yourself, right?  That’s called self-tolerance – when you don’t attack yourself.

I mean, we all make a few antibodies to different tissues.  An antibody is like a little strobe light that your immune system makes to tag what it thinks is an invader…or a dead cell that needs to be cleared out…or a cancer cell.

Then your T cells come by – and they see the strobe light and they attack it and kill it.

Well all of us make a little bit of antibodies to various organs and tissues…but we’re not supposed to make a lot of them.

Because when you make a lot of antibodies, then your T cells – your SWAT team – targets your tissue and kills it.

Depending on what tissue is being attacked, you suffer different symptoms .

In Hashimoto’s self-tolerance is broken.  It’s like a taboo’s been broken.  So now your SWAT team – your immune system – can attack anything it wants.

And it will.  Your immune system can now attack your…

  • cartilage — causing joint pain that looks like arthritis, tendonitis, bursitis
  • ovaries — causing female hormone imbalance, infertility
  • pancreas — causing the blood sugar regulation problems, you might even get diagnosed with Type 1 Diabetes or Type 2 Diabetes
  • lining of your stomach — causing inability to absorb B12 that makes you pernicious anemic.
  • cerebellum in your brain –causing vertigo, dizziness, nausea, car sickness

If you have Hashimoto’s, you need to realize that you have a problem bigger than your thyroid. 

You have an autoimmune condition that needs to be slowed down. This has to be managed correctly or you’ll  end up with problems beyond (and worse) than just low thyroid symptoms. And I know those are awful enough by themselves.

But imagine….

…having depression AND no energy because you’re B12 deficient/ Pernicious Anemic

…having fatigue AND peripheral neuropathy because you have autoimmune diabetes. 

…having hair loss AND car sickness-vertigo-nausea so severe you can’t take a trip to the grocery store

Horrible to think about–even for a second.

This is why the first thing you must do if you’re newly diagnosed hypothyroid  is demand your doctor do those tests –or find somebody else to do them.

If those tests come back negative, there’s about 23 other reasons why you could still have low thyroid symptoms.  And you need to  find a doctor that understands this fact.

If you’ve just been diagnosed with Hypothyroidism,  don’t give up hope.

Don’t get scared into blindly taking thyroid hormones without investigating whether you have Hashimoto’s. Hashimoto’s can and does lead to other autoimmune conditions that can devastate your quality of life.

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© 2011 Dr. David Clark, DC. All Rights Reserved.


Why Did Your Thyroid Gland Stop Working?

Dr. David Clark, DC director of the Center for Low Thyroid Solutions in Durham,NC provides a shocking answer to the question no one seems to ask a woman suffering with low thyroid symptoms…Why Did Your Thyroid Gland Stop Working?

Are you suffering with low thyroid symptoms?  Has your doctor ever explained WHY your thyroid gland stop working?

A common MIS-conception about thyroid disorders is that at some point….for some mysterious reason….your thyroid gland just quit working. So now you need thyroid medication.

That’s not a good answer, is it?

I mean, are we programmed so that –at some time in our life–our thyroid glands wear out, give up or shut off?  Should you just accept that kind of thinking?

You should not accept it…especially if you’re taking thyroid hormones and your labs are “normal”, but you still have low thyroid symptoms.

If this is you, then your doctor has not determined why your thyroid gland stopped working in the first place. And that’s why the “treatment” isn’t working.

When I train other doctors, my mantra is….

Always Ask “Why?”

I teach my patients the same thought process.  Ask yourself “why?”

If you have low thyroid….why did it happen?

The number one cause of low thyroid in America is Hashimoto’s.

That’s an autoimmune problem–your immune system attacks and destroys your thyroid gland. The loss of gland tissue causes low thyroid symptoms.

Even though it is the most common cause of low thyroid, few doctors test for Hashimoto’s (because they have nothing to offer beside thyroid hormones).


there are 22 other reasons why your thyroid hormones could malfunction.

(see my other posts on this topic).

That makes me pause for a second…

We’re all blaming the gland. But the thyroid gland is not the problem in many cases.

Is it the gland’s fault that your immune system is trying to kill it? No.

The thyroid gland does what the pituitary tells it to do— make the T4 and the T3, and then it’s up to other parts of the body to do their job.

There  are different players in this low thyroid story, not just the thyroid gland by itself…

The liver must convert T4 to T3.

Your GI bacteria, the good guys that live in there, they’ve got to convert T3 sulfate into active T3.

…There’s a lot of things we could talk about.  You can look at my other posts.

So, it’s not just the thyroid gland to blame. I would say 90 percent of the endocrinologists you’ll ever see or family practitioners  would say , “Your thyroid gland quit working.  Take these hormones.”

If you felt great after taking the medication, you probably would never give it a second thought. But if you’re reading this right now, you probably don’t feel good.

You probably still have some of the low thyroid symptoms you had before taking the medication….

  • Gain weight easily
  • Fatigue, low energy
  • Hair loss, thinning hair
  • Low libido
  • constipation
  • brain fog
  • Dry skin

If you’re still suffering these symptoms, then–to me—no one has asked or answered the question, “Why did your thyroid gland stop working?”

Hashimoto’s, an autoimmune condition, is by far the most common here in America, but you can also have problems with binding proteins, conversion, under-conversion….

The point is you need to find someone that understands the entire thyroid story are and knows how to track down the possible suspects.

If your doctor’s only checking TSH and T4, he’s never going to find those other possibilities I just talked about–never.

He’s never going to find


…a serotonin problem, a dopamine problem

…an under-conversion problem.

…a binding globulin problem.

He’ll miss them all.

And you suffer the consequences.

You are forced wander for years thinking there’s something mentally wrong with you…

This thyroid medication is supposed to work, but I still feel bad.

It’s not your fault.

If you are taking thyroid medication–or you have low thyroid symptoms–somebody needs to ask and answer that question…

What happened?  Why did your thyroid stop working?

Only then, when that question is answered (or at least asked), are you going to be on the path to feeling good again.

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Hidden Cause #6 Why You STILL Have Low Thyroid Symptoms

Dr. David Clark, DC Center for Low Thyroid Solutions in Durham, NC reveals yet another reason why you are still suffering hypothyroid symptoms.

Hidden cause #6 why you still have low thyroid symptoms, even though your lab numbers are “normal”, and even though you’re taking thyroid medication, is

High Levels of Thyroxine Binding Globulin (TBG)

When thyroid hormones are secreted from your thyroid gland, they have to be bound to a little carrier, a little protein.  Think of it like a taxi cab.

This taxi cab, you know the thyroid hormones, the T4 and the T3, they jump inside the cab and they get transported to the liver where they’re converted.

And then they jump back in the cab and they’re transported to the rest of the body.  So they must have this little carrier to go anywhere.

An elevation in thyroxine binding globulin (TBG) means there’s a whole bunch of taxi cabs.

In fact, there’s so many cabs (carrier proteins called TBG) that the normal free amount of T4 and T3 that should be floating around isn’t.  It’s as if they all get sucked up like a big sponge by all these thyroid binding globulins.

Here’s the crummy part about all this….

Your TSH will look normal.  Your total T4 will look normal.  Your total T3 will look normal.

If that’s all the markers your doctor is checking, then this problem is completely missed. You’ll be given thyroid hormones but you probably won’t get better.

Now you might have a little bit of a hormone honeymoon where you feel better for a couple of weeks, but eventually you’ll go right back to having depression, weight gain, hair loss, feeling cold, no motivation, brain fog.  You’ll suffer those low thyroid symptoms again.

What causes elevated TBG?  Estrogens are particulary good at elevating TBG.  Now estrogens come in a lot of different forms, right?  Estrogens can be hidden in face creams.  Estrogens are in birth control pills.  Estrogens can be elevated in a woman who’s not detoxifying her estrogens normally (liver issue).

So you see already we’ve kind of gone down the rabbit hole a little bit in tracking down the source of the elevated TBGs causing low thyroid symptoms.

If your doctor is not considering binding globulin as a possible problem, then he/she’s missing part of the reason why you could still be having thyroid symptoms.

If your TBGs are too high—Even though TSH is normal and T4 looks normal and total T3 looks normal—if your doctor will check your T3 uptake, or T3U, he/she will see tt that the T3U actually low.

(there is an inverse relationship between T3 uptake and binding globulins-one high and the other low).

Remember there’s also a lab reference range for T3U. The lab’s range is typically too forgiving. So, YOUR numbers might be within the lab’s range and look “normal”–but really your numbers are abnormal if you used a narrower range, a functional range.

Estrogens hanging out in the body elevate binding globulins, which suck up all the free T4 and T3.Therefore, not enough of the FREE T3 gets out of the taxi to attach to the T3 receptors….

…and you have low thyroid symptoms, but your labs look normal and you’re still taking medication.

Birth control pills contain estrogens.  Some face creams and cosmetics contain undisclosed estrogens (not naming brands) .  These estrogens can also elevate if you are not detoxifying estrogens normally.  Let’s talk about that briefly…

Hormones are detoxified through the liver.  So, if you have poor liver function, poor detoxification function, this is one of the reasons why you could still have a thyroid problem. It’s not a thyroid gland problem; it’s a liver problem really in this case.

Take this a step further…..what would cause someone to have poor detoxification in their liver?  The biggest factor is  blood sugar regulation.  Glucuronidation is one of the liver processes you use to detoxify hormones.  The “gluco” means glucose.  If you don’t have normal, steady glucose to supply your liver, then you can’t detoxify appropriately.

And see what happens?  You can’t just look at thyroid hormone symptoms things from the surface.  You’ve got to dig down deep and understand the physiology in order to really help someone who hasn’t been helped yet.

So what types of blood sugar problems are we talking about?  Low blood sugar and high blood sugar. High blood sugar means there’s nothing getting into the cells.  Usually that’s from insulin resistance and that can be caused by cortisol.  The other variety of a blood sugar problem is low blood sugar or reactive hypyglycemia.  These are the people that get shaky and lightheaded and irritable between meals.  Now these people don’t have any blood in their cells because they just don’t eat anything or something is shutting down their cortisol.

I don’t want to get too far off into that, but the point is…

A Thyroxine Binding Globulin problem is one reason that you could have low thyroid symptoms but have normal lab numbers, even though you’re taking medication.

I hope that you’re seeing a doctor that understands that TBGs have to be on the radar.

And if you find binding globulins that are elevated, why are they elevated?

So that’s where the detective work kicks in.  You’ve got to put on your thinking cap and start doing the appropriate testing and finding out is it a liver problem, is it birth control pills?

What’s actually happening here?  And it’s only when you start to turn over every one of these rocks, and do a comprehensive workup on someone from a functional perspective that you can help someone that’s been suffering forever with low thyroid symptoms because what they might actually have is Elevated Thyroxine Binding Globulin problem.

And taking replacment thyroid hormones aren’t going to help.

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© 2011 Dr. David Clark, DC DACNB FACFN DCCN